The committee met at 9 a.m.

[N. Sharma in the chair.]

N. Sharma (Chair): Good morning, everybody. Welcome to our third day this week — third and final day this week — of the Health Committee.

I want to start by acknowledging that we’re doing our work today on the unceded, traditional territories of the Squamish, Tsleil-Waututh and Musqueam people. I’d just like to invite all committee members to think about how that shows up in the work that we do.

This morning, I’d like to welcome, first off the bat, Stacy Ashton, executive director of Crisis Intervention and Suicide Prevention Centre of B.C.

Welcome, Stacy. We’ll just do a quick introduction of everybody, and then I’ll pass it over to you.

My name is Niki Sharma. I am the MLA for Vancouver-Hastings and the Chair.

I’ll just go to the phone, where we have our Deputy Chair. Go ahead, Shirley.

S. Bond (Deputy Chair): Good morning, everyone. It’s Shirley Bond. I’m the MLA for Prince George–Valemount, and I am calling in from Prince George today.

N. Sharma (Chair): Trevor is going to be a bit late, but we’ll go to Sonia.

Go ahead.

S. Furstenau: Sonia Furstenau, MLA for Cowichan Valley.

M. Starchuk: Mike Starchuk, MLA for Surrey-Cloverdale.

R. Leonard: I am Ronna-Rae Leonard. I’m MLA for Courtenay-Comox.

S. Chant: Susie Chant, MLA, North Vancouver–Seymour. I think we’ve spoken on the phone.

P. Alexis: Pam Alexis, MLA for Abbotsford-Mission.

N. Sharma (Chair): Wonderful.

Stacy, you have about 15 minutes to do your presentation, and the rest of the time will be a question and discussion.

Briefings on
Drug Toxicity and Overdoses

CRISIS INTERVENTION AND
SUICIDE PREVENTION CENTRE OF B.C.

S. Ashton: Okay, thank you very much.

My name is Stacy Ashton. My pronouns are she/her. I’m the executive director of the Crisis Intervention and Suicide Prevention Centre of B.C.

I’m very honoured to be joining you here on the unceded territory of the Musqueam, Squamish and Tsleil-Waututh people.

The Crisis Centre is based in Vancouver, and we are part of the B.C. crisis line network, which is ten crisis centres located across the province that answer 1-800-SUICIDE and 310-6789 mental health, as well as regional health authority crisis lines.

I’d like to talk to you a little bit about the intersection of crisis line work, substance abuse and suicide prevention. My focus is going to be on embedding suicide prevention into the province’s response to the toxic overdose crisis, funding models that free up funds for prevention and treatment by building in least coercive and least costly crisis intervention strategies, and mobilizing crisis lines to complement and strengthen our emergency crisis responder workforce.

Crisis is never one thing. I’m going to share some training scenarios we use with our crisis line volunteers. A caller is trying to manage the loss of their father a few weeks ago. Her father was the most important person in her life, and she’s lost without him. She keeps thinking about picking up from her old dealer. Yesterday and today, she’s thought about overdosing and doesn’t really care what would happen after. She’s six months clean but not sure being clean is worth it. She does not really care if the drugs are toxic.

A caller has been struggling with opioid dependence. They’ve been on meds for schizophrenia for years, and today they’re hearing voices of their dead mother asking them to join them. They do not trust anyone in the mental health system. They feel judged and dismissed by their psychiatrist, and they have taken a large amount of opioids purchased on the street, along with alcohol. They do not really care if the drugs are toxic.

These are the sorts of calls that we get, and we handle calls like this every day. Our job is to assess the risk and connect people to help. We know that we are referring people into wait-lists. We are left with that uncomfortable reality that it might be easier to find a dealer to help with your problems than an effective health care response.

The themes in these calls mirror what you heard when Jonny Morris at the Canadian Mental Health Association described deaths of despair. That’s the grey space where we find deaths by unintentional overdose, intentional overdose and suicide.

Crisis lines don’t tend to get calls directly involving opioid overdose. As you heard from 911, those tend to go straight to B. C. Ambulance. But 15 percent of our crisis calls come from people where substance use is either the primary issue or a contributing factor to their crisis.

[9:05 a.m.]

For calls related to opioids, we’ve seen an 8.5 percent increase from 2021 to 2022, but of more concern is the doubling of opioid-related calls where suicide is a factor or fentanyl is identified as a potential method of suicide.

You also heard from the Ministry of Mental Health and Addictions that 62 percent of those who died from toxic overdose in B. C. over the last three, four years were experiencing mental health challenges. We also see studies from the U.S. that find that 26.5 of opioid overdose deaths were deemed intentional, and 20 percent were undetermined. Over half of those who survived an opioid overdose reported some desire to die prior to their most recent overdose, with 36 percent reporting a strong desire and 21 percent reporting: “I definitely want to die.”

The policy and programs B. C. has rolled out in response to the opioid crisis are practical, accessible and life-saving. They do have blind spots, and one of those is dealing with suicidality in the context of substance abuse. People have thoughts of suicide when the amount of pain they’re in, either emotional or physical, outweighs the coping resources they have available. About one in ten people will experience suicidal thoughts at some point in their life, though that’s likely an underestimate.

Nearly every person will experience fleeting thoughts of wishing they were dead at some point in their lives. Those thoughts come to us in our toughest moments, when we’re feeling our most hopeless, and in crisis work, our very best tool is asking people directly and sincerely if they’re thinking about suicide. When they say yes, we’re halfway to a solution, because that person is no longer alone with their suicidal thoughts.

Even though suicidal thoughts are a relatively common human experience, health care professionals are rarely trained to talk openly about suicide with clients or patients and, at best, rely on suicide screening tools that fail to take into account the deep ambivalence that is part of suicidal thinking.

When you do a mental health intake or you meet with a counsellor or a psychologist, the first thing they will do is tell you the limits of confidentiality. If you are at risk of harming yourself or another person, the counsellor may need to break confidentiality and take action. What action that is, is undetermined, because you don’t know what the situation is. From the start, though, we’re conditioning people to fear the repercussions of talking about suicide when they go for help.

When I worked as a suicide prevention counsellor in the school system, I would be called out to consult with school counsellors when they were concerned about a student being suicidal. I remember, one time, a school counsellor called and had me come out, just to be on the safe side. She said she’d asked the student about whether he was suicidal or not, and she wasn’t worried because he said: “Not really.”

For the school counsellor, that meant, well, he was probably fine. To me, that meant he might have had an attempt yesterday. This is typical of the kind of training that school counsellors, health care professionals get around suicide — to take things that people are saying at face value and not explore that. You may have been suicidal yesterday, but you don’t feel suicidal today, but that doesn’t mean you’re not going to feel suicidal tonight.

Myths and misunderstandings about the nature of suicidal thinking impact health policy all over the place. I have a little file of “Oh, that’s outrageous” in my desk.

I was speaking with community network managers for the primary care networks in Metro Vancouver, and they bring together those interdisciplinary teams — family doctors, allied health professionals, clinical counsellors. The clinical counsellors would be taking referrals from the family doctors and the team, including mental health and substance use issues. I was shocked to find out that suicidal ideation and behaviour is an exclusion criteria to access these clinical coordinators. Yeah, I know. It’s like: “What? That’s weird.”

That means that substance users at highest risk of an overdose death are barred from what is meant to be a highly accessible source of holistic care. It also means that if you want care, you’re likely to lie about your suicidal thoughts.

In the presentation from the Ministry of Mental Health, you heard that 72 percent of people who died by overdose had seen a health care professional within three months of their death, and 38 percent of people who attempt suicide do so within a week of seeing a health care professional.

[9:10 a.m.]

Tragically, one of the risk factors of suicide is a perceived apathetic response from a health care provider or institution. People want to live, even when they want to die. When we create policy and procedure that discourage people from talking about suicidal feelings, even unintentionally — even with the best of interests, of intentions — we trap people in those places of isolation and despair.

My first recommendation is to engage suicide prevention professionals, like our team and our network, to ensure your opioid response empowers health care professionals to talk directly and openly about suicidal thoughts and incorporate that as part of a drug use safety plan. The tools are very similar to harm reduction. You talk openly and practically about how this person is going to keep themself safe and what they need to have in place to do that. That is what our crisis line volunteers do every day on our lines.

My second recommendation is to ensure robust alternatives to coercive mental health treatment and involuntary hospitalization. You heard from West Coast LEAF and from Hawkfeather Peterson at the Parents Advocating Collectively for Kin. They talked about how parents with substance abuse issues risk losing their children to foster homes if they ask about safe supply.

Substance users with suicidal ideation or behaviour are faced with a similar uncertainty about their freedom. Fully disclosing suicidality risks a wellness check from police, a trip to the hospital and possible involuntary commitment. So you can see where there would be reluctance to do that, to really get the help that you need. These kinds of restrictive and coercive approaches have the effect of further traumatizing people while they’re in the middle of crisis, which escalates the distress, fear and pain and makes it much harder to stabilize folks.

This is where I want to talk a little bit about funding models that free up funds for prevention and treatment. You heard E-Comm, 911, and you heard Donald Grant and Carrie James from E-Comm Professionals, the union, talk about the challenges facing 911 and ambulance dispatch operators, as well as front-line paramedics and other emergency responders. You heard Jonny Morris talk about balancing our investment in treatments like trauma therapy with upstream prevention efforts.

It’s true that prevention pays off in the long run, but where you’re really going to save your money is in investing in effective crisis intervention. Every crisis is an opportunity to reset somebody’s trajectory, and you can make a lot of impact in those moments.

Currently our mental health and addictions crisis system is heavily skewed to the most restrictive, most coercive and most costly interventions. You’re looking at that revolving door where 911 gets a call, police go out to do a wellness check, and that person is either left at home, possibly unsafe, or taken to the hospital — half the time not meeting the admission for hospital criteria — and then left to find their way home alone.

If you count up all of the people who’ve been involved in that crisis incident, we’re looking at…. We were estimating that through our de-escalation services at the crisis line — we de-escalate 98 percent of our calls — we’re saving about $49 million a year in policing costs alone.

We’re aware that dispatch centres measure their calls in seconds, and their model relies on assessing the problem and shunting it to the appropriate service because when the services are overwhelmed, they can’t get to the next call.

Crisis lines aren’t dispatch; we are an intervention. So 98 percent of the time, we’re really the only intervention that’s needed that day. We’re able to time shift a crisis into other days because we get the person through that point and get a plan to go forward with.

We assess suicidal risk with every single caller, and we work collaboratively to identify reasons to live, safe support networks and those pathways to hope. We also coach families and friends on how to talk to people they’re concerned about, and we can do outreach calls instead of police-led wellness checks.

We also have models…. Fraser Health has a model that works directly with their substance use teams to do warm transfer to the substance use teams, because the idea is you should only have to do one call for help. We have these models in place, but we are not necessarily being leveraged strategically within the emergency response system.

[9:15 a.m.]

So my recommendation is the same as I shared at the budget committee: bring crisis lines, 911, B.C. Ambulance and the Canadian Mental Health Association’s peer-assisted crisis teams and crisis mobile response work together and create 911 levy legislation that will support a crisis mental health system that actually works. We have a potential source of new funding in that, in the 911 levy that you could place on cell phones, which is something that is in most other provinces.

I want to take a couple of minutes to talk about workforce, because I know that that’s been a question that’s been coming up again and again around these issues. Staffing shortages across the emergency response and health care system really are straining the ability to respond to the toxic overdose problem at the level needed and, really, to any other of our mental health challenges that we’re facing.

The crisis line workforce has capacity for growth. The B.C. crisis line network operates in ten communities: Vancouver, Surrey, Richmond, Nanaimo, Prince George, Vernon, Kelowna, Trail, Cranbrook and Williams Lake. We have physical call crisis centres across all of those communities.

Every year we train 450 volunteers, each of whom commits to a minimum of 250 hours to the line. We mostly operate on hybrid staff-volunteer models. That’s considered the most effective best practice in crisis lines. At the Vancouver crisis line, 80 percent of our crisis line responders are volunteers, and 20 percent are staff. Most of our staff have been hired directly from our volunteer pool.

We have exceptional completion rates for our volunteers and exceptional staff retention. We are extremely protective of our volunteers’ and staff’s mental health, so our organizational culture leans heavily on being humans instead of superheroes and getting the front-line support you need to actually stay in the job. We can’t afford to burn out our staff or volunteers, any more than any other service can afford to do that. But we organize our culture according to that.

We have an incredibly robust training calendar in Vancouver. We train a new cohort of 25 to 30 volunteers every two months, and then we repeat that six times a year. So we’re just bringing people on the lines all the time.

I can talk a little bit about where…. You may know that all of our centres are moving on to a single call centre technology, which is great. That’s going to allow us some economies of scale. That’s where that kind of centralization is really important, but the advantage of having centres in different communities is we all get to absorb a different volunteer pool.

We are able to get the numbers we need to make this model work by absorbing volunteer pools in many places, and we leave those communities with hundreds of volunteer alumni who can go on to become your paramedics, your social workers, your 911 operators, etc.

We’re not part of the care economy conversation right now. In many ways, crisis lines are kind of…. We’re left out of the conversations at the tables where these strategies are being decided. Again, we can’t be used strategically that way. So we have quite a lot to offer that we’d be happy to bring forward.

I want to open it up for questions here. Yeah, that’s my thing.

N. Sharma (Chair): Okay. Thank you so much.

We’ll go first to Pam.

P. Alexis: Thank you so much. Thank you for your overview. Very comprehensive. I’ve had several friends, actually, that were long-term volunteers for the organization. So bravo.

We have heard through COVID that we had a society that lacked in connections, and consequently, the use of alcohol and drugs escalated. Can you tell me about the impacts of COVID on what you experienced, or as your organization experienced, with respect to spikes, trends — anything at all that you can share with us as a result of that lack of connection?

S. Ashton: What we saw directly was a big increase in the number of calls that were coming into the crisis line. So our calls increased by about 25 percent. But there are days where….

Before COVID, we would average 100 and 128 calls a day. There have been days that are 300, 400 calls, and we don’t have the capacity to answer all of those calls because our funding model is not designed to allow us to answer all of the calls.

[9:20 a.m.]

My contract with the Vancouver Coastal Health Authority required me to answer half the calls, which is clearly not enough. But that was the funding level that we were given to work with. That’s one of the reasons why, at the Vancouver Crisis Centre, about half of the money that goes into the crisis line is donations and funding through grants. The 1-800 line and the 310 mental health line, in particular, only paid 9 percent of the costs of answering those calls.

We have seen a funding lift, in the movement over to the Provincial Health Authority, but it pretty much matches the COVID response funds that we received during COVID, which means it’s not actually going to be able to lift the number of calls that we are currently taking. So that’s a big concern for us, because that really doesn’t allow us to do the work of taking calls from 911, taking calls from B.C. Ambulance, where a crisis line would be more effective and cheaper than a dispatch.

Yeah, numbers are up. The good side of it is that people are actually doing what we tell them. They’re reaching out for help. In a lot of ways, the anti-stigma work is working really well to encourage people to reach out for help. We have to follow through on the promise that we’ll be there.

M. Starchuk: Thank you for your presentation. Yesterday I asked a question with the E-Comm people about the fourth button and integrating a mental health call into 911. We didn’t really get the answer that was there.

We see that funding becomes an issue. In theory and in practice and from what you’ve mentioned, if there was a fourth button, that would alleviate a lot of costs. It would alleviate a lot of handholding between the 911 call taker and a B.C. Ambulance dispatcher. Now it’s not there.

Have you taken a look at that fourth button, where it applies to other jurisdictions, and what the cost savings would be and then how you could possibly take some of those cost savings to fund what you have?

S. Ashton: Yeah. I think you used the term “handholding.” Our job is handholding, right? That’s what we do on the crisis lines. That’s the intervention that we provide. We hold your hand through the crisis and get you stabilized. That’s the appropriate response to a lot of the mental health calls that come in through 911.

We also have been taking…. All of the ambulance operators are smart, but some clever ones have started…. When they have a person on the phone who’s medically stable but they’re alone and frightened, they’ll send them over to us on the crisis line so that we can be there and start working on their aftercare plans with them while they wait for the ambulance. We’re, effectively, taking a lot of the trauma out of those emergency situations by being able to be there.

In jurisdictions where you really lean into your crisis lines…. Your crisis line is like your air traffic control on your crisis. Crisis lines will take calls directly from the community. We’ll take calls from 911. We’ll take calls from ambulance. Anything that doesn’t necessarily require an immediate in-person response comes to the crisis line. We get a crack at de-escalating it. If we can’t de-escalate it, it’s ideal that we are able to refer to mobile crisis response teams, which have a chance to de-escalate in the community.

In those kinds of models, you see about an 85 percent de-escalation rate on the phone, as opposed to what you heard from Donald yesterday about…. Well, the only response to those calls by 911 is to send a police wellness check. Then you see a 67 percent resolution rate with your crisis mobile response team when that’s brought in.

In a full system, you’re also able to put people into crisis stabilization beds. Often what people need in that situation is a couple of nights of sleep, right? You’ve been awake for a million years, and you don’t have a place to sleep. Once that’s taken care of, again, you can get back in control of your own life and adjust that trajectory. There’s this amazing opportunity to do that.

N. Sharma (Chair): Shirley, go ahead.

I just also wanted to say we have MLA Doug Routley on the phone as well.

Trevor, did you want to introduce yourself?

T. Halford: Yeah. Sorry for being a little bit late there.

Trevor Halford, MLA for Surrey–White Rock.

N. Sharma (Chair): Okay. Go ahead, Shirley.

[9:25 a.m.]

S. Bond (Deputy Chair): Thank you very much, Niki.

Thanks so much for your presentation. I certainly appreciate the work that the crisis intervention line does here in Prince George. I appreciate that.

A couple of themes continue to emerge in what we’re hearing. One of them is that people on the front lines, including those who are drug users themselves, feel like they’re not at the table when policy decisions and discussions are made. You brought that point to the forefront as well.

One of the most powerful things you said is that you should only have to make one call. I think that is so critical. When people are in distress, they’re not going to stop and think about what phone number to call. They know one number. Typically, I would assume, it’s 911. I really am very interested in your comments about bringing organizations together and looking at how we integrate crisis support line work.

You mentioned a levy, and, as I understand it, I believe there’s a levy in place in the majority of provinces — I don’t know about territories — across the country. Maybe, could you explain to us how the levy would work and how you see there being a venue for dialogue that would look at integration of the services? I just thought that “You should only have to make one call” is a very powerful statement and something I’m going to remember. So the levy — and are there currently venues where you all come together and have these discussions or not? If not, what would that look like in your mind?

S. Ashton: There aren’t venues right now, and largely that’s because we’re considered a mental health service and not necessarily an emergency response service. We wouldn’t be part of the 911–B.C. Ambulance conversations. My suggestion is: bring together a task force with ministry support across mental health and PHSA and public safety so that we can have that conversation.

A 911 levy is pretty straightforward. Every cell phone user pays about a dollar a month into the pot. What’s beautiful about that is that it increases with the population, because the more people we have, the more cell phones we have. It’s got a nice inflation protectant in there. It’s just a basic look at the number of cell phones in B.C. right now. It looks like about $58 million a year, which is substantial, right?

Right now, I think, you’re seeing that 911 levies have been used specifically with 911. But in the U.S. they’re starting to use levies to support their 988 suicide prevention and crisis line network. There is a growing interest in the idea of: why don’t we have levies that can support both of these things hand in hand? What the legislation does is it helps protect the funding.

I heard Johnny talking about the softness of mental health money. It’s the first thing to get cut. Well, if you can legislate mental health crisis lines into your 911 levy legislation, you protect that and create a sustainable, untouchable pot of money that is designed to address those issues on that emergency basis. So, yeah, I think it’s a matter of bringing us together and sorting out the legislation and using it to fund the system we want.

S. Bond (Deputy Chair): Niki, might I just ask one quick follow up, technically? Legislation’s been put in place in those jurisdictions, and that money becomes a dedicated fund that is then dispersed — primarily, I guess, at this point, to 911, but would also give the opportunity to include crisis intervention. So it is a dedicated fund that is put in place by legislation, so it doesn’t go into general revenue. There’s a specific budget line for that. Is that right?

S. Ashton: Yeah, that’s right. The idea behind that is that it’s essentially a user fee. If you have a cell phone, you have the opportunity to call both 911 and your crisis lines. That money goes towards supporting those services.

R. Leonard: Thank you for your presentation. I have a couple of questions. The first one is: earlier you said that — I didn’t quite hear which it was — 15 or 50 percent of your calls are related to substance use as primary or contributing factors?

[9:30 a.m.]

S. Ashton: Fifteen.

R. Leonard: Yes. Thank you for that clarification.

In my community on Vancouver Island, we used to have a local crisis line. My recollection — it’s kind of vague now — is that it got absorbed into a greater crisis line, and we lost that volunteer base. I was wondering if you could comment on that. I was really interested when you talked about the workforce and where volunteerism can lead into careers.

S. Ashton: Absolutely. Yeah, I think…. I mean, the idea then was: “Well, there are so many crisis lines. We should start centralizing them.” One of the things that happened as we moved to the Provincial Health Authority is they asked us to have one lead agency per health authority, which we were able to do.

Again, there’s that idea that centralization is going to have benefits, and the centralization of taking the calls does. But when you want to mobilize a volunteer workforce, and when part of what you’re able to do is skill-up communities really effectively, you actually are better off having centres spin up all over the province and be able to absorb those volunteer pools and build out your workforce and provide those opportunities. We do this in Trail. We do this in Williams Lake. We do this in Vancouver. This kind of model can work in small communities and large communities.

R. Leonard: Okay. Thank you.

N. Sharma (Chair): I have a question. I think it’s a really remarkable kind of community connectedness that the organizations that do crisis line support have — the fact that there are 400 or 500 volunteers that are part of this.

I guess my question is…. I wanted to dig a little bit deeper into diversity and cultural competencies in the crisis line. Do you track demographics or languages or who’s calling and how you’re able to support different needs when people are there and how that shows up? What about Indigenous people that might be calling? Do they access the service and that kind of thing?

S. Ashton: There is a dedicated First Nations crisis line, the KUU-US line, that is funded through the First Nations Health Authority. But we do get calls from Indigenous folks from all over the communities.

One of the places that we don’t have great stats on is a lot of the demographics of our callers, because that’s not what the focus of our questions is. We’re not an intake service. Our first question is: how can we help you? Then we go from there. If somebody happens to tell us their immigrant status or their gender identity, we’ll know. Otherwise, we won’t.

I think what we’ll see when we move into a centralized call centre is that it will be easier to track those kinds of stats and pick those kinds of things up. That’ll be really helpful. I mean, that’s the other benefit we have in being a completely no-barrier system. We’re a good litmus test of what’s going on in the province.

I can’t really speak to the stats right now because that hasn’t been something our funding has allowed us to build out.

N. Sharma (Chair): What about languages that you offer and things like that?

S. Ashton: We are using the same translation services model that 911 and ambulance and the rest of health care uses. We will do a three-way call with an interpreter.

N. Sharma (Chair): Okay. Gotcha.

Any other questions, Members?

S. Furstenau: Thanks so much for your presentation. I just want to clarify. You said you get 300 to 400 calls, but you can’t answer them all due to funding levels. So what happens to the calls that don’t get answered?

S. Ashton: If they’re to the 1-800-SUICIDE or 310 mental health line, our calls transfer over to Surrey, and Surrey has a crack at answering them. But they really just bounce back and forth between our two most busy centres in the province.

That’s a design flaw in how the routing was initially put in. At the time, it was to try and make sure that urban calls went to urban centres, which would have a more robust understanding of local services. But the downside is that you end up transferring between the two busiest lines.

The calls to our regional lines go to a voicemail. The Vancouver line goes to a voicemail, which is, again, not ideal at all. There are lots of people who aren’t going to be able to leave a voicemail or have a safe callback, but that’s what we’re able to do right now.

[9:35 a.m.]

S. Chant: Thank you for your presentation, Stacy. Nice to see you in person. How exciting.

You talk about the calls having increased significantly during COVID, and also…. Tell me: other than numbers of volunteer staff, is it actually a…? I don’t understand how funding and the number of calls, other than staffing, are correlated. How does funding limit a number of calls, other than staff issues? You’ve got volunteers. Walk me through that, please.

S. Ashton: There’s actually math that governs how you do staffing on call centres. Any of the hotel reservations can do this and can predict the workforce that they need. Basically, the calculation is: how long are your calls, how quickly do you want to have them answered, and what’s your service level? If you want a service level where 95 percent of your calls are answered in 30 seconds, you plug in the numbers. It tells you that, well, you’re going to need 40 staff. So you can run the numbers on that at any point, and it’ll tell you exactly how much staff you need.

It’s not unknown. It’s just that there has been…. The other piece of it is that as…. You get remarkable economies of scale. You’ll find that you’ll add five new responders onto the lines, and you’ll be able to increase your pickup by 20 percent, instead of what you would if you just did one-to-one math. If you double your call responder volume, you triple or quadruple your capacity to take calls.

So the math is there. Honestly, that’s what I go by. I look up all of the call centre math and figure it out from there. That will be able to predict how much [audio interrupted] you need. So it’s not actually that much of a mystery.

S. Chant: Okay. So you don’t have any physical limitations as in capacity of phones or that kind of stuff?

S. Ashton: I mean, we do at this point. But the technology, moving onto a web-based call centre, allows us to…. Some of the centres are already into that kind of model, and they’re more able to have remote workers working from home. Like I said, you can spin up centres in any community, and that really allows you to have a robust network.

M. Starchuk: Thank you for everything that you do. I mean, it has to be, sometimes, a job that just seems never-ending.

There are a couple of things that you had said. You talked about a $49 million cost savings to policing that’s out there, so that we’re not — I believe we heard it yesterday — sending somebody out with a uniform, a badge and a gun to de-escalate a call that’s there. That’s just not the right service to go there.

With regards to your crisis lines and your call centres that are out there, how much of the province do you capture?

S. Ashton: Well, wherever you can have a phone, you can reach us. That’s essentially how that works. We have the problems around the places where you don’t have any cell phone coverage, so those would be issues. But we don’t really have any limits around that. If you have a phone, you can call us. That’s how that works.

S. Chant: I thought of something else after I stopped.

When you talk about the mobile group, does that actually exist, or would that be something we would like to create?

S. Ashton: It exists in a couple of different models across the province — Car 67 and those kinds of things. It used to be that when I was on the lines in the ’90s, I could direct refer over to Car 87 — I think it was — in Vancouver. Now we don’t get to do that. It goes through the access and assessment centre at VGH, and it’s not available for emergencies. It’s fully booked. So I wouldn’t consider that a mobile crisis response team anymore.

In the Interior and the Island, they do have crisis mobile response teams that have police involvement but aren’t police-led. There are, I think, nine teams on the Island. I’m not sure how many in the Interior. But in both of those places, crisis lines are the intake lines or the public-facing line to get to those, so we have the capacity to direct refer over to the crisis mobile teams.

[9:40 a.m.]

The other thing that you might have heard from Jonny is the peer-assisted crisis teams. Those are piloting in North Vancouver, New Westminster and Victoria. Those take advantage of peer support workers working with mental health professionals.

Any and all of those models could be integrated together into a crisis mobile team approach that would allow you to put the people on the ground that you needed at the time.

S. Chant: Do you think that there’s benefit…? I don’t know how to phrase this, because I’m trying to stay very neutral. Is there a benefit in having mobile response teams that do not include the police? Recognizing that sometimes things are unsafe, therefore, sometimes, you need that piece. Or you need to enter somewhere. Usually when I went with the police, we had to get in somewhere.

But there is a benefit, perhaps.

S. Ashton: Yeah. I mean, there is…. When you actually look at jurisdictions where you have crisis mobile teams that don’t automatically include police, what you find is that they rarely have to call out police, right? So 2 or 3 percent of the time, the situation escalates to a point where they have to call police out, and then the police come because they’re available. They’re not there 100 percent of the time.

Even in the models that we have here, one of the benefits of having police is less that they’re available on the teams and more that they liaise with their own detachments and encourage police officers to call and use the crisis mobile response teams. So they’re really more of a PR connection to encourage police to use these alternate services than they are possibly needed on the ground.

N. Sharma (Chair): Okay. I have another question. We’ve heard from other people that came before us. They talked about…. The kind of people that the coroner’s report talked about that ended up dying from overdose had different interactions beforehand, whether it was with emergency services or possibly a crisis line, and there were points of intervention. I heard you talking about that as well.

I’m just really interested in knowing…. Another perspective that you helped me understand or learn from is the whole idea of the suicide and fentanyl connection — the fact that we don’t know, but some of them, possibly, could have been intentional. I think the stats that you gave us were from the States, right? Do we know, in Canada or B.C., what that…? It’s hard to know.

S. Ashton: I’m not sure. I haven’t seen it in the coroner’s report. That’s where you would see whether they’re judging these deaths to be unintentional, intentional or undetermined. If they’re making those assessments, that’s where you would find that.

N. Sharma (Chair): I guess maybe…. I know you’ve commented on this a little bit. I’m just really curious about your perspective on the connections between when you see people or hear from people on the crisis lines, the harm reduction services, the kinds of treatment services — that whole ecosystem of the continuum of care we talked about — and where you think those connections might be made, between the crisis line and that.

S. Ashton: I think the model that they’re using in Fraser Health right now, where crisis lines have the ability to directly refer over to their substance use access teams and to do those warm transfers over…. The more we have those kinds of protocols in place, the easier it is to make sure that people get connected to the right place.

There’s a zero-suicide initiative that has been recently launched in, I think, four of the five health authorities right now. The Northern Health Authority hasn’t signed on to it yet. That’s through the Canadian Mental Health Association. I’m working to get myself on that table, too, because it’s another place where you want to have your crisis lines and suicide prevention professionals involved.

The idea there is that in a health care system, everyone should be able to talk openly about suicide and make those assessments and weave that into your care plans. That’s a way that you can take accountability for the lives that you have in your hands.

N. Sharma (Chair): Interesting.

Any other questions, committee members? I don’t see any.

It’s my pleasure, on behalf of the committee, to just thank you for coming here and not only for the work that you do and how many people you connect in community through this work and how many lives you save but just for also teaching us your perspective on the role that you have in this crisis. Thanks so much for coming this morning.

S. Ashton: Thank you. I really appreciate being asked.

N. Sharma (Chair): Great. Okay, committee members, we have a 15-minute recess.

The committee recessed from 9:45 a.m. to 10 a.m.

[N. Sharma in the chair.]

N. Sharma (Chair): Okay. I want to welcome Vicky Waldron, on behalf of the committee, from B.C. Building and Construction Trades Council. Thank you so much for joining us. We’re really eager to learn from you today.

My name is Niki Sharma. I’m the MLA for Vancouver-Hastings and the Chair of the committee.

We’ll just do a quick round of introductions. Some members are on the phone. I’ll just go to the Deputy Chair, who’s on the phone.

Go ahead, Shirley.

S. Bond (Deputy Chair): Good morning, Vicky. Shirley Bond, the MLA for Prince George–Valemount, and I’m calling from Prince George this morning.

N. Sharma (Chair): Doug, do you want to go next?

D. Routley: It’s Doug Routley. I’m from Nanaimo–​North Cowichan.

I’m on Malahat territory today.

T. Halford: Trevor Halford, MLA, Surrey–White Rock.

M. Starchuk: Mike Starchuk, MLA, Surrey-Cloverdale.

R. Leonard: I’m Ronna-Rae Leonard. I’m the MLA for Courtenay-Comox.

S. Chant: Susie Chant, MLA, North Vancouver–Seymour.

P. Alexis: Pam Alexis, Abbotsford-Mission MLA.

N. Sharma (Chair): Excellent.

Vicky, you have about 15 minutes for the presentation, and the rest of the time will be for discussion and questions. Over to you.

CONSTRUCTION INDUSTRY
REHABILITATION PLAN

V. Waldron: First of all, thank you very much for inviting me here to talk about an issue that is very personal to me, and it’s also so very important when we’re talking about the opioid epidemic in general and, specifically, the construction sector.

As we said earlier, my name is Vicky Waldron. I’m the executive director of the Construction Industry Rehab Plan. Commonly, it’s known as CIRP, so I may refer to it as CIRP as I’m going through the presentation.

I’m here to speak to you today about the impact of the opioid epidemic on the construction industry of British Columbia. CIRP is a union- and employer-funded industry program. It has a 45-year-long history providing substance use services to the construction workers in British Columbia and Yukon territory as well.

We provide long-term mental health and substance use services for construction workers. And not just construction workers, but construction workers and their family members as well. The service is no fee at point of care. So it’s free when people come to seek help. We provide residential treatment, and we provide trauma counselling to our clients, amongst other things as well.

We provide services based on three foundational pillars. That’s prevention and promotion, treatment and building resiliency. The reason we do that is we recognize that addiction is a very complex issue, and it requires a holistic approach if we’re going to be even hoping to make a dent in what’s going on. So that was a very deliberate and focused way of designing our program.

Our industry has been devastated by the opioid epidemic, and I don’t think it’s overstating it to say that the industry is in crisis. There is not a meeting that I attend anymore where somebody at the table is not telling me about another worker — a funeral they’ve had to go to, because they’ve buried another worker — or a colleague or a friend that overdosed recently. It just doesn’t happen. Every single meeting I attend, someone will pull me aside or speak openly and talk about the overdoses that are occurring.

I also see the ripple effect of these overdoses that are occurring and finding that when I meet with colleagues within the industry — the union reps, the site supervisors — they themselves are now struggling with the trauma of yet another person. I see the anxiety. I see the fear when I’m speaking to them, and the absolute desperation for help, because they’re just worried that they’re going to have to go to another person’s funeral and speak to family members about what’s happened.

You are, I’m sure, well versed in the numbers and the statistics from the coroner’s office and the other agencies in British Columbia relating to the opioid epidemic. So instead, let me paint for you a picture of what we estimate are the numbers of people impacted by the opioid epidemic within the construction sector specifically.

CIRP has long been committed to helping construction workers not only through primary treatment, but also through education and raising awareness. So we partnered with WorkSafeBC not long ago to try and understand the issues that might be contributing to the high numbers of overdoses that we’re seeing and the high numbers of substance use that we’re seeing within the industry.

We discovered quite a lot of things. But of everything we discovered, perhaps the most significant finding was the fact that construction workers reported that substance use is so prevalent within the industry that it was difficult to tell whether their own use was problematic or not. So what we heard loud and clear was: “When I look to my left and I look to my right, everybody is using. So I’m not sure that the amount that I’m using…. Is this a problem, or is it just recreational at this point?”

[10:05 a.m.]

That was quite a significant finding for us. Similarly, it was the same thing for mental health. What they told us was that when they’re looking around at their peers within the construction sector, everyone seemed to be struggling with the same thing. Everyone is under strain. Everyone is under stress. Everyone has anxiety.

So again, with it being a very macho culture, people weren’t really sure whether what they were experiencing was actually stress or whether they just needed to suck it up and pull up their bootstraps and get on with it. Is this just normal? That was the other thing that came out of this study quite strongly.

Our research also revealed, unsurprisingly, that stigma is significant, whether it’s real or whether it’s perceived, and that was an important distinction when we did this research. As one worker put it, stigma is quite simple. Nobody wants to admit that they’re not tough enough mentally in the construction sector. Being overwhelmed is viewed as being weak and not up to the job. Stigma is actually preventing people from asking for help.

While stigma exists across all industries, the impacts and the consequences for disclosing substance use issues in the construction industry are actually huge. Because of the safety-sensitive nature of the industry, disclosure has a much higher chance and higher likelihood for loss of wages for workers. Workers are also likely to be sidelined. We hear often about workers that simply don’t get called for jobs because they disclosed substance use.

Not only is stigma coming externally; the stigma is so ubiquitous that the workers themselves are actually self-stigmatizing. This is another thing that came out of the study. They see themselves as weak. This is really largely to do with the culture of the construction industry, the machismo culture that exists, the very masculine culture that exists. So they are actually judging themselves to be very weak, lazy, stupid and incompetent. Those are direct quotes that we had from when we did this research.

We found that the industry itself expressed substance use as a significant concern. So the industry is now raising this as a concern themselves. They are recognizing that there is a real problem with substance use within the construction sector.

We found that approximately one-third of all construction workers self-reported problematic substance use. That’s one-third with self-reporting. So when we asked the question, “Do you think you have a problematic substance use issue?” — yes. More often than not, this also remains undisclosed to employers.

Almost 40 percent said they struggled with mental health. Now, when we compare this to the one-in-five stats that we’ve seen quite commonly from the CMHA, that’s significantly higher. When we asked, specifically, “Have you ever misused drugs or alcohol or experienced addiction?” almost half the respondents, one in two, reported problematic substance use: “Yes, I have an addiction.” And 60 percent said they knew a colleague with an addiction, and 70 percent said that they had worked alongside someone who was impaired in the last six months.

In addition to the work we do with external partners in attempting to understand the issues that our industry faces, we also collect our own data at CIRP. In the last year, we’ve seen a 64 percent jump in the number of people accessing CIRP for services — for mental health and substance use services. We have answered 6,500 calls last year, in one year — 6,500 calls. We’re a tiny organization. We’re a private organization. We’re not open to public. Yet we received 6,500 calls for help last year. We conducted 542 intakes into our program. We delivered 4,500 counselling sessions last year.

So 88 percent of our clients will report alcohol and cocaine and marijuana as the primary substances of choice when they come to us, 79 percent of our clients will screen positive for PTSD symptoms, 81 percent will screen positive for early childhood traumas, and 80 percent will screen positive for moderate to severe depression. The numbers are similar for anxiety as well.

[10:10 a.m.]

While we are very proud of the work that we do at CIRP — I’m extremely proud of the work that my team does — we still face significant challenges in delivering the services that are needed to the construction industry. The challenges we face are challenges such as access to beds. We need greater access to beds, access that is timely.

On average, our clients are waiting approximately two months for a treatment bed — two months. So when someone calls us and says, “I’m ready to come into treatment,” we then have to tell them…. Even though we have our own beds that we privately contract, those beds remain at 100 percent capacity at all times. Even beyond that, when we are accessing publicly funded beds, we are having to turn around and say to those clients: “We’ve got a two month wait.”

We develop programming to try and hold onto those clients so that they don’t change their minds or so that the situation doesn’t change. They don’t go off to camp. We try really hard to keep them. It’s very difficult to keep someone when they say, “I’m ready today,” and you turn around and say: “Well, there’s about an eight week wait to get you into a bed.”

We need more access for women. There are very few beds available for women with small children. Almost always when we get female clients that come in and they need residential treatment, one of the first things they will ask is: “What about my children? Can I take my kids with me?” There just aren’t any services for that. So they will simply say: “Well, then I’m not going.” We can’t help them with residential treatment when that’s the case.

We also need increased access to beds around the province. There is such a lack of beds around the province. We deal with clients on the Island, all across British Columbia and the Yukon. The further north and the further you go outside of the Lower Mainland, the more difficult it is to get beds — very, very difficult to get beds. Clients will often refuse to come down to the Lower Mainland to get residential treatment. They simply drop off.

We also need greater access to long-term supports, such as master’s-level clinical counselling. All of our clinicians that we have are master’s-level clinical counsellors. They are concurrent disorder specialists as well. But we struggle to recruit.

I’d also like to speak to you today about a new issue that has occurred since COVID, an issue that I’ve never encountered in over 25 years of working in the addictions field, an issue that is threatening the ability of organizations such as ours, non-profits, to actually deliver substance use services.

Post-COVID we’ve seen an incredible upsurge in people accessing counselling for issues related to mental health and addictions, mostly mental health. But we have an inelastic supply of counsellors to deal with this upsurge. We don’t have that. Counselling has never been more normalized in the whole time I’ve been in this career, for 25 years plus. In the last year, two years since COVID, people are more likely to access.

What this has led to, in my industry, which is the mental health field, is a red hot market for practitioners. The situation is really exacerbated by the fact that counsellors are now turning to private practice in droves, absolute droves, in a red hot market. In private practice, even a newly registered clinical counsellor can charge upwards of $135 an hour, which, as a non-profit, I cannot pay. I cannot match that as a non-profit. I cannot match that. So it makes recruitment for those in non-profits such as ours almost impossible.

A case in point. We’ve had two postings for two vacancies remain unfilled for six months. We have done everything possible to try and recruit to fill those postings. Meanwhile, our counsellors are struggling with an ever-expanding caseload, as demand for services just keeps increasing. They just keep on increasing.

We’re not alone. My colleagues in other non-profits are expressing the same concern, the fact that we cannot recruit and retain counsellors. We are even offering higher wages than you would normally pay for counsellors. The normal rate is around $40 an hour. We are offering $60, $65. Just yesterday I had an interview with somebody, a newly qualified counsellor. I offered them $65, and they turned it down. You just can’t get counsellors at the minute.

Now, while the construction industry isn’t alone in facing recruitment challenges post-COVID…. We’re hearing this across the board. You’ve just got to turn on the news. You’re hearing about the airports that are struggling to recruit.

[10:15 a.m.]

The consequences of unfilled positions in the mental health and substance use field are dire. People are quite literally at risk of death as they sit on wait-lists due to staff shortages.

Finally, with your indulgence, I’d like to end by speaking to another unexpected consequence of the increased demand for counselling services. We are now seeing newly qualified counsellors opening up their own private practices straight out of school in droves. The issue of a lucrative private practice is resulting in inexperienced rookie counsellors either taking on extremely complex substance use clients or simply choosing not to work with the addictions client population because it’s too complex. I hear that again and again. “I don’t deal with addictions because it’s too complex. I just deal with mood disorders.”

It’s an incredibly complex health condition, especially when you start looking at chronic substance use issues. I always give an analogy when explaining why this is a serious issue. You can provide me with a hammer and a nail, and you can even send me to school to learn how to use that hammer and a nail. But when I come out of school, my skills are not the same and cannot be compared to that of a journeyperson — you just can’t compare that — who has years of experience under their belt.

It’s the same with counsellors. It takes years and years of experience to get to the point where you would be considered able to deal with complex substance use issues.

What we have is…. Not only are people coming out of school. They are going into private practice. They are running a private practice without the need for clinical supervision. Clinical supervision is something that usually occurs when you work in an organization. It costs a lot of money. In private practice, it’s not mandated. You don’t have to have this. So in private practice, many new students, as they set up their private practice, are foregoing this.

In the same way that rookie counsellors don’t have the same skill set to be dealing with such complex and relapsing conditions as chronic substance use, resulting in clients not getting better — or worse, they’re all getting disillusioned with counselling — many times…. We will often hear…. Clients will come and say…. “Why did it take so long for you to come in?” “Well, I had a really bad experience with counselling. I gave up. That’s it. I’m not coming in.” Or clients, when they’ve been asked to come in by their employers or their union members: “Counselling doesn’t work. I’ve tried it before.”

Not only are non-profits such as ours struggling to recruit and retain counsellors. We have the growing problem of rookie counsellors treating extremely complex conditions relating to substance use due to a red hot private practice market.

We need more oversight and regulation, in my opinion. We really do. In my day, when I started out — as I said, 25 years ago — I wouldn’t even have dreamt of opening up a private practice. The normal practice was to work three or four years in an organization. They give you clinical supervision. You get peer supervision. We have now started marketing ourselves as an organization that offers a lot of training in an effort to try and recruit new counsellors. You would work for a while, and then you would set up your private practice. That just doesn’t happen.

In my mind, if you are dealing with an opioid epidemic, if you are dealing with complex substance use issues, there should be a requirement that you have a further X number of hours that you have to do in an organization with peer supervision. Clinical supervision must be taken.

To summarize, we have an industry that is really challenged with substance use issues. It is prevalent and widespread. The industry recognizes this, but we are struggling with resources. We are struggling with issues that we didn’t expect to come up, in terms of recruitment and retaining clinical staff to deal with this, and we’re struggling with the lack of beds.

N. Sharma (Chair): Thank you so much, Vicky.

We’ll go to questions. We have Susie, then Pam and then Trevor.

S. Chant: Thank you very much for your presentation. Thank you for painting a picture for us that is so very real.

Given that we’ve got booming construction, lots of stuff going on that construction needs to be part of, and the difficulties that it’s facing, it’s…. I can see where I would be overwhelmed, and I don’t know why you’re not.

I spoke to someone, somewhere, the usual, and they said: “Employers will test for cannabis use. I’ve moved away from cannabis, and I use other things.” That puts them at greater risk for the toxic substances. Are you finding…? Is that something that is validated within the discussions that you have with people?

[10:20 a.m.]

V. Waldron: Yes. Clients will tell us…. They try not to use marijuana. It depends on where they’re going.

Construction workers talk. Everyone knows what’s going on at any one jobsite, what’s being tested and who’s doing what. Depending on that, they will move over to something else. What we often find is coke. Cocaine is something that people will move over to quite frequently.

The industry isn’t tolerant of cannabinoids — period. Medical marijuana — it’s not tolerant of that. We’ve tried to do some work around raising awareness around that, around the fact that there is a difference between impairment and intoxication. We’ve tried a lot of that, but there is a resistance to any kind of substance.

So yes, sorry. In answer to your question….

S. Chant: So that’s a disconnect, really, between the employers and the workers in terms of perception. Am I understanding that properly?

V. Waldron: Yes. Not really understanding medicinal marijuana versus something that somebody is buying from the street or even a pharmacy.

S. Chant: May I have one more?

You spoke about women workers in construction. The first thing they ask is a “What do I do with my kids?” kind of thing. Your beds, specifically — do they have a capacity to take a person and their kids?

V. Waldron: No. We previously had a residential treatment centre, which we’ve had for 15-plus years. Due to kind of structural issues, a number of different reasons, we had to close that down. We are fully planning to build our own residential treatment centre. We’re looking to build, possibly, a 16- to 24-bed treatment program for construction workers. That’s some years away.

In the meantime, my job was to kind of figure out: what do we do in the meantime? Do we simply not offer this? Well, for me, that’s not an option. We have to provide residential treatment. It’s one piece of a larger puzzle. And also, residential treatment can only be one piece of the puzzle. It really isn’t the…. It’s not the end of the road. It has to fit into a larger, long-term program of services that you offer.

What we did was actually go out and procure rapid-access beds within treatment centres, one of which was a co-ed program. When we are purchasing these rapid-access beds, we have criteria. The program must be a clinical program; there must be master’s-level clinicians, which is the best practice; and there must be concurrent disorder specialists as well. What we’re not doing is we don’t try and get beds in recovery-type places. We make sure it’s a clinical program.

So no, in answer to your question. We do have one that’s a co-ed facility, but they don’t have facilities for children.

S. Chant: Okay. Thank you so much.

V. Waldron: Incidentally, when we do build our program, we fully intend to have child care services integrated into our program. That’s one of the things that we had committed to.

P. Alexis: Thank you for your presentation. I would like it if you could share a copy of your presentation, absolutely, because it has some very important numbers for us. My riding, in particular, has many, many in the trades who are impacted.

My question to you is: given that we know it’s somewhat normalized, how do you communicate with the membership? Knowing what you know, how do you go about sharing information that might feel relevant or important to them enough to read and to engage, given what you’re tasked with?

V. Waldron: We spend…. That’s actually a really pertinent and important question. I always say we could have the best program in the world, but if the word isn’t getting out there, if the word isn’t spreading, it’s useless. So that’s a very key part of what we do.

A lot of my time is spent going out into industry. I do a lot of presenting at conferences. I go to unions and speak at their executive leadership board levels. I talk to non-unionized organizations as well. We don’t limit it. One thing that I’m extremely proud of within the B. C. Building Trades and the Construction Labour Relations Association is that even though this is a paid-for service, we don’t say no to me going out and raising education awareness if a competing association asks us to come over. We always go over and speak.

[10:25 a.m.]

So it’s really about that. I work closely with the executive boards, with Brynn from the B.C. Building Trades. I work closely with Ken from the Construction Labour Relations Association. We really work hard at raising the profile and kind of getting education out there.

As I said, part of the program that we do is…. One of the pillars that we have is prevention and promotion, and because of that pillar, we really focus a lot of our time on doing the education and awareness.

For example, this year one of the things that I’m planning as part of my new priorities for this fiscal is…. We are hoping to run some industry round tables, and we would love to have some guests, yes. As part of that, we’ll be delivering some education and awareness. We’ll be inviting industry as a whole to come and attend.

We spend a lot of time talking. We provide a lot of resources. We are in the process of developing a CIRP app at the moment. The CIRP app is something that we’ve spent a lot of time and effort and energy on.

What we realized…. As I said, we’re a very small organization. We are only an organization with ten employees — that’s it — and we serve a membership of approximately 40,000 people. So when you start extrapolating the numbers, you can start to see that it can be quite overwhelming. We needed a way…. I needed to figure out a way of how we can start getting some of these services out to people without the need to simply keep hiring more and more people to deal with this issue. An app was one of the things that we came up with.

Onto this app, we are actually taking strategies and techniques that we use in a counselling session in our program. We are converting them into self-help training modules, and we’re putting them onto the app.

The idea is that there might be workers out there…. There’s a huge number of workers out there who aren’t ready to pick up the phone and actually say: “Vicky, we need help.” They’re just not ready for that. So the idea is to put that….

Once they download the app, it puts those skills and training modules into the hands of those workers that aren’t quite ready. That’s another way that we’re looking at getting information out about what we do. We’ve got self-help videos. We’ve got resources on there, mental health and awareness training for the apprenticeship colleges — for them to download and deliver to their apprentices.

In addition to the app, the other thing that we do is work closely with some of the apprenticeship programs, the training schools. So we have embedded into those programs mental health awareness, and prevention and promotion training is in there as well.

One of them is… A couple that I can name off the top of my head are…. We call it a stress inoculation workshop, and it’s really about how to manage stress. Again, we’ve heard that so many construction workers are struggling with stress, and stress is a precursor to substance use. We know that. It’s not necessarily a disorder, but certainly it can be a precursor to starting to drink a little bit more or use substances.

We do that in the workshops, and the feedback on those workshops that we do has been really phenomenal. We’ve been doing that for about four years now, where every time they do a new class, we rotate that training in.

The other training we do in those colleges, training schools, is something called building resiliency. This is really about saying: “How do we keep those people that are healthy, healthy? How do we make sure that they don’t end up in that population that are using substances?” So it’s really bookending it.

It’s also to say: “Well, if you are on that verge, how can we pull you back and keep you resilient?” So we do that resiliency training as well. That training, I have to tell you, has just been…. It has just blown up people. We get a lot of requests to go out and do that training.

So we get information out by doing trainings, presentations, raising awareness. It’s just constantly pounding. I’m sure I’m quite unwanted at some tables, but I refuse to give up, and I bang on doors until I’m let in, kind of thing. That’s really it.

T. Halford: Thank you for the presentation, Vicky. Just in terms of…. If a worker is going to seek treatment, in your experience, if a worker takes that step…. I know every situation is different, and the worksite can be different. But what would that worker be coming back to? Are they protected? Are they coming back to a worksite? Are there compensation issues? That’s going to be calibrated in their decision — whether or not they’re going to be going to seek treatment, right?

[10:30 a.m.]

I know it’s probably different if it’s unionized or non-unionized, but if you’re able to comment on that.

V. Waldron: For sure. We are a unionized sector, but I can actually speak to the non-unionized sector a little bit. When we did the research, when we partnered with WorkSafe B.C. to look at this, we did actually deliberately look at non-unionized and unionized. We didn’t want to look at just our industry. We wanted to look at both.

The response was that, actually, if you’re non-unionized, you’re less likely to ask for help, even more so than unionized construction workers. Now, within unionized construction workers and non-unionized construction workers, there is not an appetite to actually seek help — mainly, as I said, because of the fact of the stigma that’s occurring.

Anecdotally, I can tell you, from the program, that what we learned is the stigma tends to be vertical, not horizontal. What that means is the workers are quite happy to talk amongst their peers around the fact that they’re using, but they’re not willing to go up to their supervisor. There is such a concern. I think it’s a legitimate concern, where….

We’ve got all of these pressures going on in the construction sector. We have an industry that’s predicted to have a shortfall in workers. We’ve got an industry that’s booming, a shortfall in workers. There are all these pressures. Then you have people that have substance use issues as well. So the chances of them getting sidelined are quite high. People are needed to be fit and healthy in coming to it, so if you turn around and say, “I have a substance use issue, and I need to take time off,” you’re going to get sidelined because there is such a booming industry, so they’re going to call somebody else in.

The other thing that happens is when we see clients, we track clients, and one of the things that I’ve always been committed to is making sure that we collect data so that we really understand what’s going on. Everybody is offered a 12-month treatment program, of which residential programming is one aspect. We have psychoeducational groups. We bring in families to help, because it’s a systemic issue when we look at substance use. It’s a family systems issue as well. So we bring in everybody when we’re working on this. That is the goal.

That doesn’t happen very often, unfortunately. Most of the time, clients will come to us, and they drop off at the three-month mark. That was happening so consistently that we wanted to understand why. Why are they dropping off at three months? There’s no fee associated with this. Why are they dropping off?

That’s the period that they can go in between jobs before they’ve got to go back to another job. We lose clients at the three-months mark quite regularly because they are going back to work or they’re going to camp. People come to us….

We did some work with the Fraser Health Authority. This was some time ago, about four years ago now. What we found then was that most people that came in to see us did not tell their employer. They did not tell their employer they’re coming to it. Or even when they’d go into residential treatment, they would wait until they were in between jobs before they actually accessed help. If they got called, they would drop out of treatment and go back.

S. Bond (Deputy Chair): Thanks very much for your presentation. It’s actually very hard-hitting when you hear…. Your comment was that when you talk to members, and I wrote it down in quotations, everyone is using. I think that while the coroner’s report points out that this is a group of people deeply impacted, I’m not sure that British Columbians recognize the depth of the issue that you presented on today. It is substantive and incredibly concerning.

I have just two questions. One — the work that you do. Here in the North, for example, we have the Northern Regional B.C. Construction Association. Do you work with associations like that? Are they part of the work that you do? Are there regional connections?

V. Waldron: If there is not, we are quite happy to work with like-minded organizations. We are a private enterprise. We are working with the B.C. Building Trades and construction labour relations. They are our funders.

[10:35 a.m.]

However, we are quite happy to work with, as I said, like-minded organizations. I would have to speak to my chairs — and my board, specifically — around partner organizations, but I am confident that we would be happy to work with other organizations as well.

To be fair, we’ve tried very hard to do this. Recently, just prior to COVID, actually, we had worked…. I think it was something that took three or four years to get together. We pulled together a committee of competing construction associations, something that has never been done in 40 years. We pulled all the heads of these associations together to form a joint committee to try and look at the issue of the opioid epidemic in construction.

The committee is called CISCO. You must forgive me. I didn’t come with the complete list of the people that are on that. We’ve got the B.C. Construction Association. I believe Vancouver Regional Construction Association sits on that committee as well. We’ve got members from…. I apologize. I don’t have the complete list of who’s on it, but it’s a fairly large committee.

S. Bond (Deputy Chair): What’s really important is that this is a cross-industry issue. This isn’t who you’re affiliated with or what organization you’re a part of. Construction workers are dying across our province.

V. Waldron: Yes. Correct.

S. Bond (Deputy Chair): Maybe, for the Chair and to Artour, it would be good to hear from this joint coalition that has recently been formed, on whatever they are doing.

I mean, it is a cross-industry issue. That is my concern. I applaud the good work that you are doing. I know that there are efforts underway here with the construction association here, but again, there needs to be an overarching sense of urgency around how significant this issue is. Maybe it’s possible to hear from members of the joint committee, or whoever, to see what industry as a whole is doing.

I want to just explore whether or not…. I mean, this is a very physical industry. People are physically taxed in this job. Is there work that has been done on…? Does injury, does opioid prescription, for example…? Is that one of the pathways to the problem here, in terms of the physical nature of the job and being prescribed? That is a somewhat different circumstance than that of some of the other presenters that we have heard from. Is it commonplace for this to have started from an injury perspective and through that particular avenue?

Finally, I’m wondering. I know there was an announcement about a program. I think it’s called the tailgate toolkit, or something like that. I think it was a substantive amount of money that was put towards that. I think at one time it was $1 million or something. Could you just speak to whether or not that’s a tool you use, and how effective that is?

My two questions, then, on the pathway to addiction: do you have information about whether it’s injury-related and the impact of a program called the tailgate toolkit?

V. Waldron: Absolutely, there is a correlation between injury and the consumption of opioids within the construction sector, for sure. We know that within the construction sector there’s a 77 percent higher injury rate than there is in other industries. Now, that’s a high number, but when you stop and think about it, it’s to be expected. It’s a very physically demanding job.

We also know — and you’ll have to forgive me, because this data is pre-COVID — that one in five prescriptions in the construction sector was written for opioids. Whether that’s still the case today, I don’t know, but that used to be the case.

When you put that into perspective…. When you look at other industries, you’re looking at between 2 and 5 percent of all prescriptions written for opioids. There is definitely a correlation between pain and the number of overdoses and the addiction that’s occurring within construction.

[10:40 a.m.]

To address this…. Again, prior to COVID, we have spent, I think, 18 months developing a….

I was hearing, loud and clear, from construction, from employers: “We need something to help our employees with pain that doesn’t involve opioids.” Once they start using opioids, they get caught up because of the safety-sensitive nature of the industry. They get caught up in testing issues. That’s where…. Once they get caught up in that, then they’re turning to illicit drugs because their prescriptions get cut off.

Employers were telling me time and time again that we need to come up with something different. So I did some research. I spoke to colleagues. I spoke to a wonderful practitioner, Barb Eddy, who’s a nurse practitioner in the Downtown Eastside. I used to work with her some years ago. She is now practising myofascial release. This is a non-opioid intervention, and it’s really effective in relieving pain.

We worked with Barb for about 18 months to develop a clinic where we were addressing pain without opioids. The idea was…. We had myofascial release. We had restorative yoga. We had restorative physiotherapy. We were in the early stages of working with Pain B.C. to come up with some classes around pain. Pain is a subjective issue. We know that there’s a lot of psychology involved in pain as well.

We came up with an entire program, 18 months of work and development. We launched it in January of 2020. In March, COVID hit, and we had to pull the plug. That was quite devastating to us, I’ve got to tell you. I can tell you that for the very…. I think it was only up for two months, but in the two months that we ran this as a pilot, we had staggering success.

Now, I always caution and say that the sample size was small because we only ran it for two months. Even so, we had a 100 percent success rate in a reduction in pain for construction workers that came and joined that clinic. It was really good. We’ve struggled to get that back up and going post-COVID. We’ve really struggled with that.

There is a connection between pain and opioids. Sorry, you had asked about whether pain starts the substance use issue. I don’t know….

S. Bond (Deputy Chair): It’s okay. I just wanted to have on the record the sense that this industry is…. There is a different, potentially characteristic….

I don’t want to take all of the time. The tailgate toolkit — are you aware of that, and do you use it?

V. Waldron: Absolutely, yeah. The tailgate toolkit is something I’m very familiar with. I’ve chatted to the folks that are doing that. We’ve worked with them on that. Yes, we do offer that to our clients. We offer a whole range of resources.

One of the things that we found when we did the research with WorkSafeBC was…. There are resources, but one resource doesn’t fit all people. There has to be a huge variety of resources so that people can find the one that fits for them. That is why it’s one of a fair number of resources we offer. It’s also why we’re developing the CIRP app. There’s a whole different range of resources that people can access for the same issues.

For example, the app will say something like: “Do you struggle with anxiety?” When you go into…. It will have those as the front things. “Do you struggle with addiction? Do you struggle with depression?” Whatever it is, you go in, and in behind that will be a whole range of tools for you to use.

N. Sharma (Chair): Vicky, I just wanted to let you know. We’re obviously very engaged with this. We have about five questions and about 15 minutes. I just want to make sure everybody gets a chance to ask you.

Go ahead, Sonia.

S. Furstenau: Thanks so much, Vicky. This has been fascinating. I’m trying to…. You’ve given me so much to work with here. You’ve talked about the culture of the industry. Then CIRP has ten employees. It sounds like you’re trying very hard to participate in shifting things, but with 40,000 people in this industry, that’s a lot of burden.

When you talk about the apprenticeship programs…. Are those required? Is every apprentice coming in and getting access to that training, or is that optional? And is the cultural shift…? How do you see that happening in a way that gets us to a different place with the culture?

[10:45 a.m.]

V. Waldron: The training — we don’t do it with all the colleges. We started off with one, just because we wanted to pilot this and see if we could perhaps then reach out for partners to help us to continue it and make this a sustainable program. We started with one. They’ve been running it for four years. It’s embedded into their curriculum, so every student that comes in. It’s expanded. The other unions, locals and training apprenticeship colleges heard, and they said: “Hey, we want that too.” So we’ve done it. I think we’re up to four now that do it.

We’re at capacity in that my team cannot go out and deliver that anymore or any more schools into that, mainly because, like I said, we are struggling to fill counsellors. We have vacancies that we just can’t fill. We’ve got increasing numbers of caseloads. Our caseloads for our counsellors just make my head hurt. We run the risk of burning out our counsellors, and we don’t want to do that either.

We still haven’t rolled it out to every apprenticeship program, which we would love to do. But we haven’t, because we just don’t have capacity. We are capacity-tapped. There are three, that I can think of, apprenticeship programs that run it just routinely.

I should also say the other program that we run through the colleges is the Kit in Every Hand program, and that is that we are a registered naloxone site, so we provide naloxone kits to construction workers as well. We did actually want to roll that out provincewide. Cisco was actually part of that program to roll that out to all construction workers and all construction sites. Included in that would be education and training as part of the naloxone program. If we can have a vehicle by which we can also insert that training, we’re going to do it. Sadly, funding for that was declined, unfortunately.

R. Leonard: Thank you. Like everyone else, I really appreciate the perspective that you’re bringing. I wanted to go back to who you are. You are a non-profit that is funded by the trades council?

V. Waldron: Yes.

R. Leonard: So it’s basically funded from union dues?

V. Waldron: Correct.

R. Leonard: Okay, so the part that I’m starting to see in the bigger picture here is that the work you’re doing is incredible. I appreciate Sonia’s question in terms of normalizing. If we all go into it expecting that there’s going to be injury, pain and potential addiction, we all know that everybody’s going to be stressed. If you start from that level, you’re starting from a better place.

What about the construction industry? Not the employees, but the employers. Because I’m seeing that, as you said, it’s that vertical piece. Is there work being done within the industry to work with the construction companies and those who are involved in management to change attitudes, to really work with you to make change?

V. Waldron: Certainly, within our sector, I can speak to that, for sure. It’s all part of it. It’s what we do. So when we speak to unions, we’re also speaking to employees and contractors as well. Yes, we do. That’s part of the industry round table. We hold three: one in the Lower Mainland, one on the Island and one in the Interior. Employees are being pulled in there.

In terms of the stigma, when you spoke about that, that’s quite an interesting thing that’s come out of the work that we did. I think there’s often this misconception that the employer is the Big Bad Wolf and they just don’t care about the employees. That’s not what we heard. I can tell you, in the six years that I’ve worked within the industry, I’ve never heard that. It’s always been: “We are worried sick about our employees.” What they do say is: “I’m afraid to go near it with a ten-foot barge pole, because I might make the situation worse.” Because they’re not mental health professionals.

We do a lot of that — this building resiliency. We do that with employers. We reach out to employers and say: “Hey, we’d like to do this with your workforce.” Generally, people are so…. Again, I speak for our industry or our sector of the industry. They’re very happy to take that help and do that work.

As much as they want to be helping, what I often hear is: “I don’t know how to help.” That’s what we often hear, and that’s often where the education comes in. I’ve worked with employers on the Island, for example, and I work with them around setting up a mental health committee for their organization and how to run that committee and what to do with that committee. So there is work being done. There is education that we do with employers.

[10:50 a.m.]

But in terms of the stigma, it’s not coming from the employer, which is why I started by saying “stigma, whether real or perceived.” There is a perceived stigma that if you disclose to your employer, you’re going to be sidelined.

N. Sharma (Chair): Doug, on the phone, go ahead.

D. Routley: Thanks very much for this. It really hits me deeply. My stepfather was a contractor, and I worked for him, and I’ve worked for road builders and painters and electricians. I would have saved this for the deliberations, but I’d like to say that you acknowledge what is absolutely true. It mirrors the whole don’t-ask, don’t-tell thing.

The stakes for the employers, in terms of costs of injuries and costs of employees who are using, are so high. The stakes are so high. But the reality is that…. I mean, I’ve worked for contractors. The employers themselves are using. It was a culture: “You’re tough.” You’re always hurt. You are strong enough, then, to go on, finish your day and go drinking with the crew and smoking and on and on. It’s so prevalent.

Partly, I think, as you indicated, there are so many flows into the addiction, through injury and prescription of opiates, which I didn’t experience back when I was working in the industry. [Audio interrupted] that it’s a low-barrier industry to people with low training, that have records of drug possession or impaired driving and all of those things…. There are a number of reasons that the culture is what it is.

I think the zero-tolerance piece of it really inhibits anyone coming forward and speaking and being honest about what’s happening because of the consequences. That doesn’t help anyone. I really deeply appreciate you bringing this out this way and speaking to the non-union side of it, as well, because I can definitely speak to a difference between those two worlds.

More a comment and to share with my colleagues how important it is that we acknowledge and not expect that it’s going to go away but somehow come to terms with being able to cope with it and help people out. Thank you.

M. Starchuk: Thank you for your presentation. I happen to have a close relationship with somebody from the B.C. Building Trades. They are always talking about your Lifeguard App that’s there. We talked about the tailgate toolkit that’s there. I believe that’s WorkSafeBC’s program that was there. I’m not 100 percent sure.

Because you’re so tied in with WorkSafeBC, has there been any appetite to get your app out that way so that all people in the industry can take a look at it? According to my source, when you open up the app, it just opens up everything that’s there. It’s more of a younger generation tool that’s there as opposed to somebody getting a hard copy of something and thumbing through it.

V. Waldron: We’re not connected to WorkSafe. I don’t know that we have a real tie to WorkSafeBC, not that we don’t want that. I would be very happy to have that. I just don’t want to mislead you and say that we have these two-way avenues that are happening. We would love that.

I am very open to the app being spread further and used widely and utilized widely, absolutely. One of the things that we always say — and my board are great at saying this, as well — is that we may be unionized, but our construction workers are working shoulder-to-shoulder with someone that may not be unionized, so the issue is an everybody issue. It is not a B.C. Building Trades issue or a VRCA issue, it’s an everybody issue.

In answer to your question, we’d be very happy to work with spreading that app.

N. Sharma (Chair): Okay. Thank you. I have a couple of questions.

[10:55 a.m.]

First, I just want to say thank you so much for this. I feel like we were all missing this piece of the information when we were hearing about how the crisis was showing up, which was the construction industry.

I found, like most of my colleagues, your stats very shocking — how high it is. I think a couple, more than one, have alluded to this idea of: what is it about the industry? What is it about the industry that leads to this and has such high stats that are very shocking?

I guess I have two questions. One is: is this council that you’re talking about, that’s coming together, actually looking at what the causes of this are? I’m wondering if some of the zero tolerance stuff is driving people to use it. It sounds like most people are dying at home by themselves. Is somebody looking at the cause of this and how we can figure that out first, and then figure out what we need to do to fix it?

V. Waldron: Gosh, that’s a million-dollar question. What is causing this? It’s complex. It’s an incredibly complex situation. From my perspective, I would love to do some more research and work on this. But as an outsider coming into construction, I can tell you that it’s just….

When I do these presentations, I say that we’ve got a perfect storm. All we needed was for one variable not to be there, and I don’t think we’d be in the mess that we’re in now. But we do have the perfect storm. We’ve got a shortage of workers. We’ve got a male-dominated industry. We’ve got a construction boom. We’ve got lots of clients that are really struggling with pain. We’ve got clients that are struggling with traumas. Why, I couldn’t tell you. But that is what’s happening right now. All of those collectively have really….

The other thing is that most of our industry is made up of small contractors; 80 percent of the industry is made up of ten or less employees. When you have ten or less employees and one of your employees is off, that holds up your entire contract job for a while, until you can find somebody else. There’s a lot of pressure that goes on.

The CISCO committee is newly formed, and we’re trying to figure out what it is we want to do. But this is definitely something that I would be…. We have started having conversations around this. I’d be happy to bring it back to the committee and let them know that the Chair of this committee had asked. I can bring that back to them, for sure.

N. Sharma (Chair): That would be interesting.

Just a quick one. I wonder…. You talk a lot about stigma. I guess you have some self-reporting, but it’s anonymous, or you were able to get some data, but the stigma keeps people from talking about it. Do you think that decriminalization is going to have any impact on that stigma? How does that show up for you in the work that you do? I’m just curious what you’re thinking about that.

V. Waldron: If I take off my construction hat for a moment, absolutely. Absolutely, it’s going to help. I think it’s such an important step towards combatting this absolutely devastating epidemic that we’re in.

If I put back on my construction hat, I think…. Is it going to have an impact on what’s happening? I don’t know, and that’s the truth. I’m not sure. The reason for that is because the issue is not the criminalization of what’s going on within the sector. It’s different issues, as I see it. Will it impact that? I’m not 100 percent sure.

N. Sharma (Chair): What’s the issue, then? You said it’s a different issue.

V. Waldron: The issues are, as I’ve said…. We’ve got construction. We’ve got pain. We’ve got…. It’s all those different — which aren’t related to criminalization of the issue.

Is it going to have a positive impact, specifically, on the construction sector? I don’t know. I really don’t know. But is it a good thing? If you ask me personally, 1,000 percent.

N. Sharma (Chair): Thanks for that.

Okay, Susie, we have time for your question.

S. Chant: What would happen if you took testing out of the cycle and just focused, instead, on if somebody’s on the worksite and not able to function, or they’re unsafe or whatever. You focus on that person at that point and not be doing the testing piece. This, to my mind, adds stress and is also pushing people into perhaps using things that they wouldn’t otherwise use that are more harmful to them and also looks at the presentation of the person.

[11:00 a.m.]

We’ve also had a number of discussions with people who are substance users and are functional people. That assumption, and I’m going to say it’s made by employers, that because you’re a substance user — maybe to manage pain, maybe to manage trauma, maybe to manage whatever — means that you can’t work on the worksite…. Those two are not necessarily co-related.

If we took testing out of the equation, maybe that would help the employers too. I wonder.

V. Waldron: You’ve kind of opened up the lid of something that’s supremely complex.

S. Chant: This was supposed to be really quick. I’m sorry. So say no. Yes. No.

V. Waldron: I don’t know that I can answer that. I’m not even fully qualified to answer that. I can answer that with one perspective only, and that’s me as a clinician. I can’t answer that from the industry perspective wholly.

I think it’s a very valid question. I think it’s a question, from my perspective, whether it’s an appreciated perspective or not, that is worth looking at. There’s nothing that’s not worth looking at, at this point.

N. Sharma (Chair): Vicky, I just want to thank you on behalf of the committee for coming here today. You can see that we learned a lot from you and were really engaged. I want to also just appreciate the work that you’re doing in an industry that’s really suffering from this crisis.

We wish you well. Stay well in your own kind of work, and thank you for coming here today.

V. Waldron: Thank you so much. I appreciate the time.

N. Sharma (Chair): Okay. If you could flip us copies, we’ll get copies of information.

V. Waldron: What I can actually do is provide you with our annual report. That is where my notes have been pulled from, so I’m quite happy to provide you with the entire annual report.

N. Sharma (Chair): Wonderful.

Committee members, we’re going to take a few minutes here to switch panels, so maybe we’ll start at 11:05.

The committee recessed from 11:01 a.m. to 11:06 a.m.

[N. Sharma in the chair.]

N. Sharma (Chair): On behalf of the committee, I just want to welcome our next speakers.

We have two people from the B.C. emergency health services: Dr. Michael Christian, chief medical officer, and Jennifer Bolster, paramedic practice leader.

Thank you for joining us today. We’re excited to learn from you.

My name is Niki Sharma. I’m the Chair of this committee and the MLA for Vancouver-Hastings. I’ll just go to the phone. We’ll do a quick round of introduction.

D. Routley: Doug Routley from Nanaimo–North Cowichan.

M. Starchuk: Mike Starchuk, MLA for Surrey-Cloverdale.

R. Leonard: I’m Ronna-Rae Leonard, MLA for Courtenay-Comox.

P. Alexis: Pam Alexis, MLA for Abbotsford-Mission.

N. Sharma (Chair): Then we have a couple more that are just joining us.

Trevor, when you get a chance, you can introduce yourself.

T. Halford: Trevor Halford, MLA for Surrey–White Rock.

N. Sharma (Chair): Okay. You have 15 minutes for your presentation, and then we’ll do about 45 minutes for discussion afterwards. Over to you.

B.C. EMERGENCY HEALTH SERVICES

M. Christian: Thank you very much, and thank you for taking the time to focus on this important issue.

I acknowledge that we’re coming to you today from where we work and live on the traditional territories and unceded territories of the Stó:lō, Katzie, Squamish and Tsleil-Waututh Nations. It’s a pleasure to be here.

We also recognize that you recently heard from Dave Deines, who’s from our union. He gave an excellent presentation, so we tried to focus our presentation on the questions you had afterwards and some of the data that you wanted. Hopefully there won’t be too much overlap. We fully endorse all the things that he had also said to you.

N. Sharma (Chair): I should tell you that we have your materials on our screens.

M. Christian: Great. We have hard copies if anyone needs it, just in case.

My name is Mike Christian. I’m the chief medical officer with BCEHS. I’m an intensive care physician by background, with a specialty in pre-hospital medicine, and a professor of critical care medicine at UBC in the background, in public health. I just recently joined BCEHS six months ago, having spent the last six years working in the U.K., in London, England, with the ambulance services there. I’m originally from Toronto, where I practised at Toronto General and started my career as a paramedic.

I’m joined today by my colleague, Jennifer. I’ll let you introduce yourself, Jen.

J. Bolster: Sure. Thanks.

My name is Jen. I’m an advanced care paramedic. I’m also a paramedic practice leader with BCEHS. I’ve spent the last ten years as an operational paramedic — I guess ten years now — and the last two of those on the front lines of the overdose crisis on the Downtown Eastside.

M. Christian: We’ll go to the first slide. This is really just a bit of background. A lot of the information you already know, but this is just some of the context for this — recognizing that although we’re here talking about the overdose crisis today, this isn’t a new issue. This is an issue that, certainly, BCEHS has been responding to since time immemorial but really since the ’80s, when this first started.

I was a resident back then and came to Vancouver, spending time on the Downtown Eastside. At that time, certainly the crisis had started with a different drug — heroin then — and is now moving over and on to injectable cocaine and now into fentanyl. The character of the crisis has changed, but our response to it and the demand that’s placed on the service has been consistent for many years.

[11:10 a.m.]

We very closely monitor the pandemic. We are a bit of a canary in the coal mine in terms of the 911 calls for this. We constantly share our data with public health and other responders to the crisis. A lot of the data that BCEHS has generated has been very pivotal in terms of identifying what’s happening with the trends. So we’re very involved at that point and continue to work.

Jen can talk about…. The day-to-day volume of this is quite significant still in its impact, but annually has been increasing.

J. Bolster: If you just switch to the next page in the slide deck there, you’ll see a graph that starts at 2015. Prior to 2015, what we saw is approximately 10,000 to 15,000 overdose cases per year.

As you can see, between the years of 2015 and 2020, a really steady increase in toxic drug events, until 2020, where we see a quite steep increase in events to where we are now, where we are seeing on average 100 toxic drug events a day, last year a total of over 35,000 events.

M. Christian: This is having, obviously, a massive impact on the demand in our service but also on the patients and what our providers respond to. As I’m sure you’re all aware — for us, the BCEHS — this isn’t an issue that’s confined just to the Downtown Eastside. This is across the province, and certainly, the rates across the province are increasing. In all health authorities, we have a significant number of events per day, with some of the greatest increases occurring in areas such as Fraser Health Authority.

So it’s, for us, matching our response in where we have traditionally had much more limited capacity. These challenges that we’ve seen down here in the Lower Mainland, and the pressure on the service, are increasing in those areas as well.

J. Bolster: Our gender and sex demographics are matched by what is seen out of the B.C. coroners service death review panel, where the majority of patients are male, approximately 75 percent, and over 40 percent of those events are between the ages of 19 and 39, where a further 25 percent are aged 40 to 59.

Although our female patients represent an unacceptably high incidence of the toxic drug events we’re seeing, the incidence in male patients is significantly higher, as represented by the blue line on the graph that you see there.

M. Christian: Sorry, for those on the phone, we’re two slides ahead now.

J. Bolster: For our current initiatives…. We have several. In the interest of time, I’ll just touch on them briefly, and then during the answer and question period, we can discuss them more at your disclosure.

Really, beginning with community paramedicine, community paramedics have a huge role to play in the overdose crisis. We do have 140 trained community paramedics throughout the province. Outside of the care provision that they provide with patients within the community, they serve a greater purpose in the public health integrated community response — being that they can actually do in-services with the public on how to administer naloxone and how to respond to an overdose.

We also have a new assess, see, treat and referral pathway, which is a referral pathway available for paramedics to patients following a toxic drug event. So where, normally, the options following a toxic drug event would be conveyance to the emergency department or non-conveyance, where we don’t really know what happens to these patients, we’re now offering patients the opportunity to be connected with outreach services following consent. Happy to discuss that further after the presentation.

We also are involved in patient engagement experience groups with people with lived and living experience of substance use. This is part of three patient experience groups with the general public with those with mental health conditions and then, of course, those with substance use. The purpose of this working group is to really foster a back-and-forth discussion about the care that paramedics provide substance users. We discuss some new and current initiatives and really obtain feedback on how we can provide better care to them.

The Lifeguard App integration, as I’m sure you’re aware, is of high benefit to BCEHS paramedics. In May of this year, we celebrated the two-year anniversary of the app’s inception. In that time, 130 events were dispatched from use of the Lifeguard App and 45 lives were saved. So I think it goes without saying that integration of the Lifeguard App with our system is of a high importance, especially for patients who do choose to use alone.

Paramedic-delivered take-home naloxone is another initiative that we have ongoing, and this is in partnership with the BCCDC harm reduction services. Since the development, or the integration, of take-home naloxone to our paramedic programs, we have distributed 6,000 kits, and that’s been ongoing since 2020.

[11:15 a.m.]

Next, we have the PHSA death review panel. This panel was created in the wake of the B.C. coroners service death review panel investigation report that came out earlier this year. The purpose of this review panel is really to understand the three major recommendations that came out of that investigation and develop an action plan that addresses each one of those recommendations. BCEHS has partnered with this panel to look at what we can do as an organization to address those recommendations.

Then next we have our Downtown Eastside paramedic bike squad. So our paramedic bike squad has been in existence since 2017, since just after the announcement of the public health emergency. They serve as highly integrated members of the community, not only responding to overdoses but also patrolling the alleys and patrolling the streets of the Downtown Eastside and checking in on patients that are unconscious, offering supplies and monitoring of chronic health conditions and not just necessarily substance use–related issues.

M. Christian: Certainly, stemming from, in part, the work of the death panel review, there’s a number of areas that we recognize that we need to improve and have identified as areas that we can still develop.

David Byres, the president and CEO of PHSA, comes from a mental health background. He is passionate about the work that we’re doing, and he’s leading this across PHSA for the death panel review. So he’s engaged with us and been asking and putting forward our ideas about what we need to be able to do some of these things. So many of these are on the list.

Certainly, one of the things that we don’t have…. Although Jen is sort of our focus-area person of expertise around this issue of the toxic drug crisis, we actually need more of them. We need to have the resources to actually have a whole strategy developed and people behind it to be able to have that expertise to inform us even greater in terms of the work that we do. This is unfortunately still, in part, done off the side of other people’s desks, with all of the other issues that we have to deal with.

Early screening and identification of at-risk individuals. This really links to the issue around health care records as well. Lots of people who are suffering from these types of issues with addiction and substance use, or are at risk of it, have connections with the health care system for many other reasons. Some of them deal with the same types of age and demographics or risk-taking behaviours, where we may see them or have an encounter with them for a completely other reason. Our ability to catch them then and actually connect them into care and the resources they need is something that we’re missing the opportunity to do.

A big part of that, also, is we don’t have a connected health record system. We have our own health care data. In the U.K., when paramedics are responding to jobs, they can actually go in and look at the care record of that person before they get there, understand the other providers that are seeing them, pick up these other issues they might have had before they reach this and have that communication, so they can actually help connect them to the care they need.

That often may not be in the emergency department at a hospital, which is probably the last place some of these patients really will get the help that they need. Those types of things are the things that we’re developing.

Then the broader receptor capacity within the system. We focus on a small segment of these patients’ care now — both at the beginning and the end, with our community paramedics. Trying to connect them into the resources — so having access to counselling, access to other things, some of the initiatives we proposed and want to do…. We’ve gone to the health authorities, but they say: “We just don’t have the capacity to take more patients from you that you want to connect into the care.” That limits our ability to deliver the care.

J. Bolster: Next, we’ll just take you through, really, the patient journey through the health care system and where paramedics have the opportunity to intervene.

At the very beginning, prior to the patient’s involvement or in the realm of substance use, we have screening. What we see is that these patients have a clustering of at-risk behaviours. Oftentimes, we see thousands of patients throughout the province daily, and what they’re calling for isn’t necessarily a substance use or a drug-related event, but it is something that we would classify as an at-risk behaviour and making them vulnerable or susceptible to substance use and addiction down the road. Things like fights, things like trauma can be things that our paramedics can flag as potential risk behaviour so that process could stop before it even begins, so to speak.

Then, moving along, really, our focus is preventing a toxic drug event once the patient is within the sphere of substance use. A really good example of that is our bike squad paramedics. Our bike squad paramedics present a very low-barrier access point to health care within the community. This is so important right now, where access to primary health care is really challenging for patients, especially who live on the Downtown Eastside.

[11:20 a.m.]

There are many ways that we can prevent a toxic drug event, things like take-home naloxone and access to drug-checking facilities. Our bike squad paramedics get drug text alerts when there’s a contaminating substance within the region. They can then take that information to patients who might be using in that area.

Following that, we have our traditional, well-known…. When people think of a toxic drug event or a paramedic-attended overdose…. That’s the reversal of the overdose itself. What is well understood is the response and how to reverse the overdose. What is less understood, and what the focus needs to be on now, is that navigation phase following the resuscitation. For us, really, it’s taking the focus away from conveyance to the emergency department, where it’s often overcrowded. Patients become frustrated, and they leave.

What this point in the journey represents is an opportunity to break the cycle, where the cycle is going to the emergency department, not being able to receive the care that they need, leaving the emergency department. They’re still within the sphere of acute withdrawal, and they’re turning to substances again. Then here we are at another toxic drug event.

Paramedics are going to be very important in the integration of alternative care pathways, where we’re not transporting to the emergency department. Instead, we’re transporting to a facility that focuses on the care of patients following the toxic drug event and acute withdrawal.

From there, opioid agonist therapy is a very promising bridge to recovery or safer use. There are paramedic services in the world, outside of Canada, that are doing this successfully, both in the acute withdrawal phase as well as in the active referral phase. In the active referral phase, we’re actually giving the patient ten days’ worth of Suboxone or buprenorphine, opioid agonist therapy that they can take on their own terms and then be connected on to a clinic that can continue their care.

Then from there, we tie in our community paramedics again, at this end of the continuum of care, where our community paramedics can support safer use and, eventually, recovery. What this whole thing represents is a continuum of care that focuses on the expanding context of paramedic practice.

M. Christian: With all this, there are many opportunities. We’re looking at our models of care. We’re looking at how to increase the diversity, develop more multidisciplinary teams, particularly in our low-acuity work, and engage other health care providers, mental health nurses, other substance use providers to be able to partner with us, in practice, in the pre–hospital setting as well.

Thank you. We’re happy to take your questions.

N. Sharma (Chair): Okay. Thank you so much.

Questions, colleagues?

S. Chant: The initiatives that you were talking about came directly out of the death panel. Is that right?

M. Christian: Some of them. There are some of the death panel recommendations. Most of the death panel recommendations are focused around a lot of access to safer supplies and things like that, which we have some connection to. Much of this has actually been developed by our in-house team in talking to the patients and the patient engagement groups and looking at what others are doing around the world.

S. Furstenau: Thank you for the presentation.

Jennifer, could you elaborate a bit on the part you said about the ten-day take-home of Suboxone or OAT and other jurisdictions that are doing that. Can you give us some more information on that? Is that happening here? Is that possible?

J. Bolster: Sure. Absolutely. I’ll touch on what’s going on in other places in the world.

Predominantly…. In the United States, it was piloted in New Jersey, where paramedics will, in the acute withdrawal phase…. Following the toxic drug event, to stave off the very uncomfortable effects of acute withdrawal, the patients are offered a larger acute withdrawal dose of Suboxone.

Suboxone, if you’re not familiar with it, is buprenorphine and naloxone. It’s a very safe drug to combat the effects of withdrawal. If the drug is manipulated in any way, it just turns into naloxone. So it’s a very safe alternative for paramedics to administer. It has been very successful in its inception, although it’s very novel. The evaluation phase is still ongoing.

It is something that we are considering. We have applied for a Health Canada exemption to section 56 that will allow our paramedics to be able to administer Suboxone. We’re currently working in the phases of being able to allow that regulation change to happen so that we can move that forward.

[11:25 a.m.]

M. Christian: I can pick up from there.

We have Health Canada approval to hold the drug and for our paramedics to do it. This is one of the broader challenges with the practice here. Paramedics in B.C. are licensed and regulated through a legislative regulation, as opposed to a college of practice, the way you would with physicians and nurses and whatnot. So change is at the pace of legislative change. Currently it’s not within their scope of practice to provide this.

We’ve spoken with Bonnie Henry. We have one option, which is to actually do a public health officer order under an emergency act. It was actually all designed for COVID, but we can also use it for this because it is a declared public health emergency. That piece is in place, and we’re having conversations with her about doing it. She’s quite willing to do that.

Then there’s just a final basic infrastructure piece. This is still a controlled and targeted substance. So we have to manage it like we have to manage all of our other narcotics in the organization. Mostly, at the moment, those are only provided by our advanced care paramedics, who have a very limited footprint, whereas we’re looking at rolling this out across the whole province.

In order to support this, we have to put safes across the province. The current price tag for that, at the moment, is several millions of dollars to be able to do that. We’re working on trying to get the capital to be able to purchase that and put this infrastructure in place.

Then the final piece is really connecting them into care. We can do this for a short period, but it doesn’t necessarily address the problem if we can’t, then, help get them into that care in the community. That’s where…. We’ve had good engagement across the province, but there are a number of areas, particularly in Vancouver Coastal, where they say they’re at capacity. They can’t take on additional referrals.

Those are the pieces that we’re working on but still pushing forward to try and get this in place.

M. Starchuk: Thank you for your presentation. I’m just going to ask one question now. Then we’ll go on to….

I’m really, really interested in the comment about transporting to a different facility. How would that work in a rural setting? I mean, we know how it would work in Metro Vancouver. You’d have to…. There are probably facilities that may be already in place where you could utilize them, whether or not it’s a primary care centre or something along those lines. But how do you imagine — I guess that’s the word — this to roll out to the rest of the province?

M. Christian: Again, it requires those other facilities to be in place. That’s the key bit. I think that we have to think more innovatively in other areas of the province. How do we connect them to other pieces of care? How can we look at more opportunities for, again, tying into our community paramedics or something to bridge people through that? We have fewer options.

I don’t know if you have other thoughts that you….

J. Bolster: No. I would just echo your points.

There are places, predominantly — again, I’ll use the United States as an example — that have just shaped their centres to be overdose-receiving centres, much akin to trauma-receiving centres and stroke-receiving centres. It has an entire area of specialists that will focus on that context of practice. Those infrastructures are in place. The rural communities will require a tailored response, for sure.

M. Christian: Maybe if I can follow on. It brings me to one of the points that we’ve discussed inside PHSA with David Byres and others — the need for what we don’t have at the moment. I know there are discussions about this.

I have my cardiac care network, my stroke care network. The other hat I wear is the medical director for trauma services for the province. We have those in place.

We don’t have an opioid crisis type of health improvement network or something where we use the frameworks of tiers of services to look at what services are available across the province in the way that is being done in other areas of our health care system. That’s, I think, one of the things that we can, then, help feed into, if those types of things existed.

P. Alexis: We had a presentation from VANDU. We had members of the community come and speak to us. One of the issues that they had was…. They wanted the Lifeguard App…. I think they called it benches. They wanted benches to be identified in the Lifeguard App.

Does this make sense?

M. Christian: For location, like geolocation?

P. Alexis: So we already do this? No.

J. Bolster: I’m sorry. It’s not familiar to me.

P. Alexis: Okay.

S. Chant: I know what you mean.

P. Alexis: Can you explain it?

[11:30 a.m.]

S. Chant: They wanted locator decals on benches. If I find somebody with an overdose, I can put this on, and it tells the system where we are. So it’s on telephone poles, benches, whatever — a way that they can communicate the location of the victim and the person calling it in.

P. Alexis: Thank you, Susie.

J. Bolster: Yeah. This is being done in some of the alleys on the Downtown Eastside, absolutely.

M. Christian: We don’t operate the Lifeguard App. It’s a separate organization. But my colleague Neil Lilley, who is the chief operating officer, was involved in the development of it and is on the board. So I’ll mention this to him. We just get the alerts once they occur. We help promote the app, but we don’t manufacture it. I’ll mention this to him.

R. Leonard: Thank you very much for your service. We hear so much about first responders and those who are facing their own trauma every day.

I guess my question is around…. We’ve seen the…. I forget what it’s called, but people who are in a pre-contemplative state…. You are dealing with people who could be anywhere on that spectrum. When somebody comes to after you’ve administered naloxone, or you take them wherever…. You’re talking about navigating a system. It implies that they want to go along that route.

I guess my question is: how do you determine — maybe it’s not in your hands, really — where to navigate to? If they’re in a pre-contemplative state, which a lot of people are, what happens then? What do you anticipate?

M. Christian: I’ll let Jen take it in a second.

I think a couple of things. First off, this is a huge area of research that we need to do, which is to understand more about that whole state of mind and the physiology of what happens with someone as they’re coming out of out of an acute intoxication episode.

I think a couple of things…. We always take patient wishes and all the usual things around consent in mind. Those are the baseline of all of our pathways. At the moment…. Until we had the ASTARs, the option was that they either got up and refused care and walked away, which is potentially a lost opportunity but maybe what the person wants, or it went to the emergency department.

I’ll let Jen talk a little bit more about the ASTAR pathways that we have for trying to offer other options. It’s really offering options to people as opposed to saying, “You have to do this or that,” as long as they’re capable to make the decision.

J. Bolster: Yeah, and where the ASTARs are really fascinating is where we do have alternative destinations to take patients. We do have referral pathways where we can transport patients to urgent primary care centres, but currently we don’t have the ability to transport patients to overdose resource centres. If we have those options, then we open a ton of doors which would otherwise not be there.

The issue right now is that we’re seeing that patients are just much less likely to want to call 911 during an event, and it’s because…. You know: “Well, what are they going to do for me? They’re going to take me to the hospital. I don’t want to go there. They’re not going to do anything for me. So I’m not even going to call an ambulance.”

Then that is concerning, because we know that patients that suffer a toxic drug event in the pre-hospital setting are at a much higher risk of mortality. That encounter with the paramedic is so important. But we really need to highlight that encounter as not just being a means to get to the emergency department but a means to get to other places. Currently, for substance use right now, the only referral that we’re able to meaningfully give them is to outreach services, which we hope will help, but we still need to do more there.

R. Leonard: What are outreach services like? Is this low-barrier kind of stuff? Is it something that’s more acceptable to somebody who is not seeking help?

J. Bolster: Sure. Yeah. It is comprehensive. So the range is quite large — anything from food to housing, to access to safe supply, to access to OAT, to peer-to-peer connection services. It’s really focused around what that person needs in that moment and the outreach team that will be the most specifically specialized to help them.

R. Leonard: Just because we’re on the record, can you explain to the public a little bit about what it’s like to go back to help somebody time and time and time again.

[11:35 a.m.]

J. Bolster: It’s hard to put in words, but I think I speak for the majority of paramedics, where there’s really this balance of compassion fatigue and helplessness. Paramedics become paramedics because they want to save lives. The traditional encounter between the paramedic and the patient that overdosed was usually one that the paramedic left feeling very rewarded, where the overdose was reversed quickly and, whether the patient was conveyed or not, it was a successful call.

To be consistently attending to not only the same patient over and over and over again but seeing them in a consistent state of suffering…. Paramedics are being exposed to a lot more overdose-related deaths. So this went from being a call that became very rewarding to a call where paramedics are leaving feeling very helpless, and there is a lot of moral distress that accompanies that.

It is hard to put into one statement, but it is something that is certainly affecting paramedics’ resilience across the system.

R. Leonard: Are there systems in place to support the attendants?

J. Bolster: I think that there are. BCEHS does have avenues that are being utilized. We have our critical incident stress program. We have resilience program trainings that were put in place for the COVID pandemic that I think we could alter to focus on the overdose crisis. Consistently, every month, we’re putting out resiliency mitigation techniques and stress and compassion fatigue resiliency strategies.

But this is a much bigger thing that comes down to paramedic education and inserting this resiliency training into paramedic education at the outset so that, you know, we don’t train people to swim when they’re drowning. This is kind of where we’re at right now with paramedics. I think the answer really is going to be inserting this into education, which I hope will be reflected in the new NOCPs that will be released early next year for paramedics.

M. Christian: If I can just add a little bit to that. I think there’s also a shifting in the profession as well. It’s moving away from that mindset. This has actually been driven by these experiences, the same as we’ve seen in…. You have intensive care physicians that are involved in preventing trauma and other things, because you recognize that the real impact you can have is in the upstream prevention and other aspects of care, the low-acuity work.

We have many of our paramedics that have been the strongest advocates for us moving and developing community paramedicine in the Lower Mainland, in urban centres, so that they can be involved. It’s not just the lights and sirens and saving the life part. It’s all the other care that paramedics can provide and other pre-hospital professionals connecting patients to care and delivering that.

So I think opening up those avenues, diversifying the career paths for paramedics as well as the care that’s provided is one way to actually help that, because you recognize that you’re having an impact elsewhere that probably has even greater impact than showing up at the end of the crisis.

T. Halford: Depending on where we are in the province or the number of calls that are coming in, you may not be the first responders on scene. Later on this afternoon, we do have other first responders coming in.

Are you able to speak to how that collaboration is going? Is there something you need? Are there areas where it’s going really well? Are there areas where that collaboration could be improved on? Is there anything that we should be noting as we go into those presentations later on this afternoon?

M. Christian: Yeah, certainly. A few things.

One of the things we definitely need is staff. We are, like many other areas of health, hugely understaffed despite efforts to recruit and to have more volume. I think that’s what they’re probably going to say to you as one of the number one things. It’s that they want more of our people and paramedics to be able to be there to help them and respond faster and get there, because they are often there. They are often there, sometimes, now, for unacceptably long periods of time before we can free up an ambulance to get there from the hospital, where they’re waiting to off-load or whatnot.

We are working with them. There are a few initiatives that are coming out. There’s the legislation that’s being drafted at the moment, which is the updated scope of practice for first responders as well as paramedics. That has an impact. There’s also a collaboration that’s being led by the Ministry of Health, which is a document based upon the Auditor General’s report that looks at the interface between first responders and BCEHS. That draft document has been going around for public consultation. It focuses on a lot of these relationships between fire and BCEHS.

[11:40 a.m.]

I’m going to hear the report from that, from the consultations, in two weeks, and then there will be new collaboration agreements that will be developed over the coming months and into next year with all the fire services across the province.

All that work is in place to try and build and improve those collaborations, but definitely, I’m sure they’ll say there’s more to be done. We were sitting down and talking about that, that we’re all aware of it. It’s just trying to overcome some of those issues around staffing.

N. Sharma (Chair): Okay. Thank you.

I have a question about the drug alerts that you were talking about. How does that work? How does that feed into the response? I’m just really curious about that aspect of it.

J. Bolster: For us, it’s really just another means to mitigate and reduce harm. It’s low-hanging fruit, at the end of the day. For us, it’s just about communicating those different resources out to paramedics so that they can get those drug alerts to their work phones.

When they start their day at the beginning of a shift, they can check their phone and look and see: “Okay, there are contaminated substances within Victoria. Okay, now, when I go to a toxic drug event or I come across patients that may be within the sphere of substance use, I can heed that warning and start to disseminate that out to the community of patients that might not have access to a phone where they can get those alerts.”

N. Sharma (Chair): We were hearing from some overdose prevention sites. Is this one of the things that you are working together with them on? We heard some of the front-line workers knowing exactly where that’s coming from, because they know the community so well. Is this a type of community paramedic work?

J. Bolster: It’s certainly something that the Downtown Eastside bike squad does daily, absolutely. The bike squad is every single day in all of the overdose prevention sites, discussing what’s coming up from the drug checking services and what areas are particularly at risk.

I think one area that we’ve identified we could do better is making sure that these resources are spread throughout the entire community and each health authority throughout the entire province, including our rural areas. Obviously, the areas that are of extremely high risk are rural areas, where they might not have as many services such as in the Downtown Eastside.

N. Sharma (Chair): How does your response change?

A big portion of the people that we’re hearing are dying are using at home. I know you have the Lifeguard App and the thing to address that. But the whole pathway that you’re offering that’s kind of a vision of how services could get to people at different stages — is that the same kind of thing that you would apply for somebody that is maybe not on the substance use disorder spectrum but recreationally using that overdose at home that you responded to? I’m just curious about that response or how it’s different.

M. Christian: I think there’s a lot of potential. Those are the patients that we want to try and identify, and that ability to connect them. Even if it’s just flagging that one event so that it goes into their health records so their family physician or other providers that are engaging with them are aware of that, for those recreational users and other events, especially because we may not even see the recreational user because of a substance use issue.

It may be because they had a fight, or they fell down, or they did something else, but our ability — the paramedics take a full medical history and capture that information — to put that into the record, particularly for all the patients that we see and treat and release and they don’t even go to hospital…. That information right now is a completely lost opportunity for that person to get help and get connected for care down the road.

I think there are some of those aspects to connecting. The person who’s home alone is very difficult for us to access, but we are one of the only providers that actually are in people’s homes every day across the province. We want to build on those opportunities with the diversification of the spectrum of care in the pre-hospital setting.

Did I miss anything?

J. Bolster: No. I would only echo what you said, Mike.

M. Starchuk: I’m really curious about the ASTAR and what’s being done now. You mentioned New Jersey. I’m aware of the northeast coast and their recovery coaching that they have embedded into ERs of certain hospitals that are over there, where they allow whatever the ambulance service is at the time to hand off that patient. Then, as you said, we can only get out there as fast as we can because we need staffing resources.

[11:45 a.m.]

I’m just wondering if that’s part of what you were talking about when you talked about the referral. Some people will say that the emergency ward, when they’re being dropped off, is not the best place to do it. Other people will say that is the best place to do it, because that’s when they’re maybe thinking about: “Maybe I don’t want to keep doing this.” It goes to your ten days’ worth of Suboxone that’s been handed over at that point in time.

I’m wondering. Right now, as far as your program that you have today, how many people is that touching today, and where does that see you going tomorrow?

J. Bolster: We have a number of ASTAR pathways that are active right now. Our biggest barrier is in paramedic utilization of these pathways.

There is a large cohort of patients that would be deemed appropriate for these referral pathways, but our paramedics are not necessarily educated or trained in navigating the health care system with these patients in a way that doesn’t land them at the emergency department. A lot of those barriers are going to be on us on educating our paramedics.

To your point pertaining to substance use particularly…. I think it’s an interesting idea, having that transition be at the emergency department. It’s not something that we have done. When we are rolling out these ASTAR pathways…. When that decision to convey to an alternative destination is made, that is the destination that they are being transported to. For substance use, really, what we are going to need to be able to facilitate a referral to centres that are appropriate for them is receptor capacity and facilities that will be able to take them in.

I’m not sure if that answers your question, specifically.

M. Starchuk: I guess, specifically…. What are we doing today?

J. Bolster: Sure. Pertaining to substance use?

M. Starchuk: And that referral program.

J. Bolster: Sure. The referral pathway for substance use, where we’re connecting patients with outreach services, is what we’re doing currently.

For our other ASTAR pathways…. We have several different pathways that will land the patient at an urgent and primary care centre instead of an emergency department.

M. Christian: Some of those are not related to the toxic drugs we have. For alcohol intoxication, in some areas, it’s the ability to take patients to a detox centre, as opposed to directly to the emergency department.

As Jen said, it’s two things. One is the integration with the communities to make…. Jen’s team and, particularly, a former colleague of hers, Richard Armour, who is hugely passionate about this and has, unfortunately, gone back to Australia, have done a ton of work in setting up these pathways.

It’s really our challenge now, and what we’re working on is how to help and have our paramedics utilize them. They were coming to a system where…. They’re used to a very transactional process. You come. You see a patient. You take them to the emergency department. That’s still the path of least resistance, in some ways, for them, as opposed to….

It’s really a changing mindset and changing the practice of the profession to being a practitioner who connects people to care, refers people on and spends more time with them on scene to do that. It takes more time and effort to make the phone calls and do the various connections. That time is well…. That investment of time then pays off for the patient down the road but, also, the system. That’s something we’re still trying to develop.

We just surveyed all of our paramedics a couple of months ago, looking at: how can we improve our ASTAR pathways? What do we need? What are the barriers for them not being utilized? One of my frustrations every day is when I look to see the number of patients that could be going down an ASTAR pathway but only the small percentage that actually are.

M. Starchuk: Thank you.

S. Bond (Deputy Chair): Sorry I missed the introductions. I’m working out of my office in Prince George and had to deal with something. So thank you for that.

I wanted to just ask a little bit about the Lifeguard App. I know that you have…. It has seen significant growth, in terms of utilization. Is there room for additional capacity? Where is it utilized best and most? Are there regions of the province that are deficit? It just seems to me that it is an important tool, but it isn’t…. A lot of people may not even know that it exists. So could you just speak to that?

Then, secondly, caring for your own members and critical response trauma and the fact that you face that on a daily basis. With the call volumes, the complexity of issues, maybe just speak to how you care for the people who care for us.

M. Christian: Do you want to take the Lifeguard App, and then I’ll take the second one?

[11:50 a.m.]

J. Bolster: Sure, yeah.

Again, pertaining to the Lifeguard App…. I think Neil Lilley, one of our senior leaders, would be very well positioned to take this question. He was involved in its development and would know the answer.

The specific data and the utilization throughout the province — we don’t have that. We do have data around the number of users, the number of events since its inception in 2020, and the fact that since its development in 2020, nobody using the app has died. Specifically to its uptake in geographical regions, we can see if we could find that out, but we don’t have that information offhand.

Certainly, what we can do, as an organization, is to put out public service announcements going over the Lifeguard App so that the general public is aware. That could be an important piece. When the Lifeguard App triggers a 911 event, there is an automated voice that will announce, from the phone, to do CPR and to administer naloxone. It would be important and effective for the general public to be aware so that — if they hear this and they’re next to a patient who has used the Lifeguard App — they can respond appropriately.

M. Christian: Neil’s role in this is separate from his BCEHS job. He has done this in his private time and as a citizen. We don’t have access to the app data. That’s all inside the not-for-profit that runs the app, but we can ask him to try and get that information for you, to see if they can. We just have limited access to how many activations and the data that comes to BCEHS.

In terms of your second question around how we care for our people, we know that this has been a big issue for them. Some of our paramedics have actually done research on this and published the impact that this is having on the mental health of our providers, as it is across the entire system. As one of our primary focuses this year is on that, we have been working very closely with CUPE, our primary union, on our critical incident stress program.

Compared to many other pre-hospital systems in the country, we actually have a very strong system of access to care, access to counsellors and support for them around that very focused program of CISM, but also, we’re broadening that out. We’ve just been approved funding to actually expand our employee experience and employee mental health program.

We’re shortly going to be recruiting for a director of mental wellness for the organization, and we’re looking at a much broader approach to this. It is a huge issue, on top of COVID, on top of all the other pressures that we’re all facing. We have a workforce, like many others, which is experiencing a lot of mental health issues.

We’re doing all that we can to try and support them with that, as I said earlier, as well as looking at those issues outside of that. How do we deal with the other aspects of their lives? There are the primary stressors around the fact that they’ve dealt with this traumatic call, this traumatic incident, but there are the secondary stressors that we’re also trying to address, such as: “Am I getting paid? What’s my work environment like at the station? How’s the rest of my stuff?”

Those are the things that we have a little bit more control over and that we’re also really focusing on. It’s to try and help the environment that people are working in and all the different stressors that they’re facing as employees and care providers that are out there dealing with this crisis.

N. Sharma (Chair): I have the final question here. One of our terms of reference is to focus on recommendations that would expand safe supply. I know that you focused your presentation on it and supported other presentations on some of that. I heard from you of one specific program that you were talking about, which is the ten days, I think, of Suboxone, after somebody has given an intervention, given that supply.

I’m just curious if you have anything else to offer specifically, from your perspective, on the ground of how you think a safe supply program could really be effective.

M. Christian: I think I’ll start, and then you can add in.

Certainly, in terms of referring to safe supply, it’s being aware of connecting patients. One of the things that I really see BCEHS’s role as — one of the things that we’re positioned well to do — is to connect patients to care. I think our role, in terms of connecting people to care is accessing or helping them access that.

If you look at our Downtown Eastside bike team, the community knows them by a first-name basis. They go down an alley, and everyone’s like: “Hi, Tom, how are you doing?” It’s like they have that relationship. That ability, then, helps provide that access and connection to care.

[11:55 a.m.]

I don’t necessarily see us, specifically, being able to deliver safe supply ourselves, for a number of reasons. But I think our ability to help connect patients with our community paramedic programs, to be able to reinforce that and help people go along with them in their journey to ensure that they’re able to continue to access things like that — those are opportunities I see there.

Any other thoughts that you had?

J. Bolster: That was well said.

I have nothing to add, unless there’s anything else clarifying you’d like.

N. Sharma (Chair): Okay. Great. On behalf of the committee, I just want to thank you for coming today with a great presentation and really a lot of passion that you have for the work that you do. I know a lot of British Columbians benefit from the work that you do.

I know, Jennifer, you were talking about how when people show up and save a life, they get that thing back that carries with them. You think about how many lives you’ve impacted from your work. So thank you for that. We really appreciate you coming.

M. Christian: Thank you so much.

J. Bolster: Thank you.

N. Sharma (Chair): Okay. Take care.

All right. We’re going to be recessing until one o’clock.

The committee recessed from 11:56 a.m. to 1:01 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): On behalf of the committee, I just want to welcome our next speakers.

We have the Fire Chiefs Association of B.C. represented by Fire Chief Karen Fry, first vice-president, in Vancouver; and Fire Chief Larry Thomas, second vice-president, Surrey.

We also have the B.C. Association of Chiefs of Police — Chief Mike Serr, Abbotsford police department; Sgt. Shane Holmquist, RCMP E division, drug advisory NCO.

Thank you so much for coming. We’re really looking forward to learning from you. We have your presentations in front of us, too, just so you know.

My name’s Niki Sharma. I’m the chair of this committee and the MLA for Vancouver-Hastings.

I’ll just go to Trevor.

T. Halford: Trevor Halford, MLA, Surrey–White Rock.

N. Sharma (Chair): We’ll go on the phone lines.

We have our Deputy Chair, Shirley. She couldn’t be here.

We have Doug on the phone. Go ahead, Doug.

S. Chant: Doug’s in a working group, I think.

N. Sharma (Chair): Go ahead, Sonia.

S. Furstenau: Sonia Furstenau, MLA for Cowichan Valley.

M. Starchuk: Mike Starchuk, MLA, Surrey-Cloverdale.

R. Leonard: I’m Ronna-Rae Leonard, MLA for Courtenay-Comox.

S. Chant: I’m Susie Chant, MLA, North Vancouver–Seymour.

P. Alexis: Pam Alexis, MLA for Abbotsford-Mission.

N. Sharma (Chair): The way we have the time allotted is we have 15 minutes per organization. Then the rest of the time, which is about 30 minutes, is for questions and discussion.

I’ll pass it over to you. I don’t know if the Fire Chiefs Association or the Chiefs of Police want to go first.

Briefings on
Drug Toxicity and Overdoses
Panel 1 – First Responders

FIRE CHIEFS ASSOCIATION OF B.C.,
B.C. ASSOCIATION OF CHIEFS OF POLICE

K. Fry: Thank you for allowing us to present today. I am Karen Fry, the fire chief for the city of Vancouver and first vice-president of the Fire Chiefs Association of B.C.

First of all, I’d like to acknowledge that I’m sitting here today, and proud to work, on the unceded traditional territories of the Musqueam, Squamish and Tsleil-Waututh First Nations.

I am also acutely aware that what I am speaking to you about today directly impacts many of our First Nations peoples in Vancouver and many other communities across B.C.

I also live on the traditional, unceded territories of the Stz’uminus First Nation in the Cowichan Valley.

The Fire Chiefs Association of B.C. represents over 450 fire departments across B.C., of all sizes and in all locations. Some respond to overdoses, and some don’t. There are various levels of responses, depending on the skills and availability of the fire departments.

I’m going to speak a little bit today about what we see in Vancouver. I would call it the epicentre. I’m not here to tell you anything that you don’t already know. For example, according to our most recent data, there have been 2,386 deaths in Vancouver since the public health emergency declared in April 2016. That is the population of Pemberton or the population of Anmore and Belcarra.

Since 2016, Vancouver fire rescue has responded to 36,802 overdose incidents. Overdose responses continue to grow. Whatever we are doing, it isn’t addressing this emergency.

In 2021, we saw an increase of 25 percent over our highest previous year in 2017. In 2022, this year alone, we are on track to meet and exceed those numbers. We are going to be over 7,700 overdoses in this city. What has changed?

[1:05 p.m.]

Overdoses are happening everywhere across our city, predominantly located in our Downtown Eastside, where we have a lot of resources available. They’re also occurring out in areas like UBC and spread throughout our city, in people’s homes and in our communities.

When you look at the slide that I’ve given to you on our naloxone, on what our firefighters are doing across the province…. I believe we started administering naloxone prior to the crisis being named an epidemic. The effective administration of naloxone by our firefighters has increased by over 430 percent in 2021. So 933 times, we administered this opioid antagonist to counter the effects of the overdose.

Why the jump in injections in the last two years? We know that Narcan is readily available on our streets and in our communities and that there are other community responders, family and friends that have access and will use it readily.

I visited our fire hall on the Downtown Eastside, where we have increased our staffing from 8 to 14 people on duty, 24 hours a day. Those firefighters — I asked them why we’re seeing these increases in injections. What they have told me and what the direct correlations are: the drugs are stronger. Benzodiazepine is prevalent, mixed with the opioids and fentanyl now. Firefighters are less hesitant to give Narcan than we used to in the past.

We have an issue with B.C. Ambulance. They are under-resourced, and we have huge delays. There are delays in ambulance, and we are waiting on scene for long periods of time. And 0.4 is not enough. We’re starting and almost needing 0.8 almost immediately.

In 2016, 2017, 2018 and even in 2020, the wait times for ambulance were negligible. We would arrive on scene. They may have received one dose from somebody else in the community. We could hear the sirens of the paramedics coming. That is not happening as often now. We are waiting longer. The system isn’t working.

What they’re also telling me is that people are not going to hospital. On the streets right now, when people are revived, if they regain consciousness, 80 to 90 percent are not going to hospital. They’re getting up, and they are walking away, and many times we are going back to them multiple times throughout the day.

What does this effect have on our firefighters? That’s one of our biggest concerns as well. We need to continue to do what we can to support our most vulnerable people that are suffering from addiction. We have duplication of services between ambulance and firefighters.

The lower-barrier housing and the housing options are not safe spaces for them necessarily, from what we’re seeing. They’re dirty. They have bugs. They’re not clean. People are using in their rooms, and this is where we have things like fires, like our Winters Hotel, where people are dying. They’re not safe spots for them to use easily.

My crews tell me that there’s no sense of community anymore. With whatever is in these drugs, it is more survival. They steal from each other, and they leave each other and abandon each other on the streets as well. Something to do with this opioid that they’re using now is affecting the way that they are surviving.

Our firefighters have empathy fatigue. They have burnout. They are being sworn at, spit at and, regularly, people are throwing things at our rigs, so our compassion fatigue is occurring. The individuals on our streets are just crossing the street regularly. There’s no sense of self-preservation.

The sheer volume and numbers of calls…. Our three-person rescue medic units — we used to have two people. We need a minimum of three now. They indicate to me that they’re not so concerned about the person, because they know they’ll come around with the naloxone, but it’s the unsafe conditions.

[1:10 p.m.]

There’s a mixture between mental health and the addiction, and addiction and mental health, and it’s everywhere down there. It is causing our firefighters to be on high alerts at all times, hypervigilance and under extreme stress. Our sick time has gone through the roof. Occupational stress injuries in firefighters are something that we are seeing every single day, and a lot of long-term firefighters are off work.

The crews tell me that one of their concerns is that there is no accountability with the users. There’s no hope, and there is despair. Multiple times they go to the same person. They get up and walk away, as I mentioned. We go back to them minutes later, when we get called back because they’ve gone down again.

The firefighters believe that the resources are plentiful on the street and that everything is free and that there’s no accountability for having free access to supplies. They think that treatment and treatment beds are the first step in a possible solution as something we need to continue to work on. We’re training to higher levels with EMR.

Our firefighters are depersonalization…. They’re removing themselves, or there’s nothing left in them when they go home. They’re getting into a blame game, and they’re not looking after themselves and no self-care. They’re getting back-to-back calls with decreased resources, cramped quarters, and the facilities for staff do not help.

When we talk about the overdose crisis and the effect it’s having on our staff, we’re rotating our staff every year, and it needs to almost be done every month out of our Downtown Eastside hall, just for the sheer number of calls and fatigue that’s occurring.

I’m going to turn it over to my colleague Chief Thomas to talk about a program that they’re running in Surrey.

L. Thomas: I acknowledge that I work and live on the ancestral and traditional lands of the Coast Salish people, specifically the Katzie, Kwantlen and Semiahmoo in my community.

The first couple slides I provided are charts from the B.C. coroner. I’m sure you’re familiar with them. I think what’s interesting in those charts…. It points out that in 2019, there was a significant dip in the number of overdoses and the number of toxicity deaths. It would appear that the efforts since then have not been as effective, and that’s kind of the crux, from a data perspective. What happened in 2019 that we’re not doing now, or what’s changed, is the question.

I’m going to skip through, because I’m watching our time here.

The Surrey fire service overdose response history. Our work has more than doubled since the emergency was declared in 2016 — similar to Vancouver, just on a little bit smaller scale. Again, we send our first responders to overdoses because we believe we can make a difference.

I provided a chart on average response times for the fire service and for B. C. Ambulance. You can see the red-line trend is not getting better with B. C. Ambulance. There’s an eight- to ten-minute window there where providing life-saving interventions will help reduce the harms and potential lack of oxygen and brain damage, and those types of things. So that’s why we’re stakeholders in this. We see all the deaths in our community, just as Vancouver is seeing.

I provided a couple of maps of 2020 and 2021 with some big purple dots to show where we’ve responded to overdoses. You can see in our geographic area that overdoses are occurring everywhere in the city. We know, from the coroner’s report, that 80 percent are happening in residences, whether they’re private residences or other residences. I bring that up because this is a lead-in to what I’m going to talk about — this data, what our actions have been so far and then what kind of opportunity for hope that I see as a potential.

We started trying to get intel. We’ve seen the workload. We did add staff to our downtown fire hall — not to the magnitude of Vancouver, but it was needed because of the call volume and the burnout of our firefighters as well.

We created a business intelligence tool, an app, that monitors clusters of overdoses by the hour. When we get a spike in the rate of overdoses, administration staff will get an alert in an email, and we also send that to the harm reduction people in Fraser Health and to Dr. Brodkin, MH chief medical health officer, so people can see what’s going on and the word can get out about bad drugs.

[1:15 p.m.]

The second thing we did is we instituted a program where if our firefighters respond to a residential non-fatal overdose, they will leave behind literature and take-home-naloxone kits for anyone that’s living in that space. Typically, people that are having fatal overdoses are using alone, and others may or may not know. It’s kind of a preventative step, if we may.

Then the third thing we’ve been doing is we piloted a program called second responder. This is a period of time after we’ve responded to a residential overdose. We’re not talking about the ones on the streets but when they’re actually in a private residence.

We have a team, which I’ll explain in a little bit more detail, and the premise is that we go back within 48 to 72 hours to check on the person. Because fire responded, we feel we can go back and see how they’re doing. Then we bring with us a team of support people that can offer assistance, which I will explain here in a little bit more detail.

There is a picture of what our overdose cluster app looks like, for reference.

Our second responder program. Again, it uses our incident response data. We work with a Fraser Health clinician and also peer support workers with lived experience. The goal is to try to decrease the number of repeated overdoses and hopefully reduce the number of fatal overdoses by providing support to people that are experiencing overdose.

This model of program — we didn’t create it. We read about it. It started, I believe, in West Virginia, where the opioid crisis really started a long time ago in the coal mining towns. Then Boston, Massachusetts, has a similar program where they leverage the first responders to make references to programs.

With this program, we simply reach out to the people. We have the peer support worker with lived experience to try to build a rapport and understanding and build some credibility while we’re there. If the client is interested in talking, then it’s great. We have the clinician there to say: “How can we help you? We just want to check on you.”

There are all sorts of pathways to different support — whether it’s counselling support, whether it’s mental health support, whether it’s treatment or recovery programs. All that literature is provided to them. The goal, again, is to try to get them the help that they want, on their terms and with their own customized plan.

I’m going to just jump to the end, because I’m conscious of time here.

Some of the services they offer: substance abuse support, custom recovery plans, social work support, support for family members that may be impacted, access to naloxone, information about the Lifeguard App for using alone and then connection to any programs.

Some of the gaps we see are that if people do reach out…. I have two gaps. I can’t get data to validate the effectiveness of this program. We know how many contacts we make, but I don’t know how many people show up at Fraser Health. Because of privacy, I can’t get that data easily. Hopefully, we can get a system where I can get aggregated results without any personal information being shared. That is one gap.

The second gap is that for people that do reach out — and I hear this from the clinicians — it takes too long for them to actually get something. This window is closing, and their addiction needs drive them back to using again before they can get help, because they have to wait.

In trying to wrap this up, I’ll skip forward to a news article that was published by the CBC in January, this year, relating to Timmins, Ontario. It’s a small town, only 41,000 people, but they had a fatal overdose rate almost double that of Surrey and Vancouver, 70 per 100,000. So they had a problem with a way smaller population.

The two doctors in their small hospital there decided to go outside of their rules and start providing Sublocade, which is an anti-opioid antagonist that stops the craving for drugs. It’s a monthly shot that the people get, and it gives them a chance to actually enter in programs and buy some time. Then if recovery is their path, it gives them that chance.

Now, this isn’t an evidence-based article. It’s a news story. It’s in the presentation I give you. But you can see that they have 130 people that were successful in changing their pathway by being on this drug. They give it to them within 24 or 48 hours., I believe in B.C. here, it’s much more like a week or longer before they can be eligible, and that window is just too long.

[1:20 p.m.]

I see a program like ours, where we’re doing outreach for people that want the support…. If they had access to this program with Sublocade quicker, in a shorter time period, maybe we could change the pathway for some of these people experiencing multiple overdoses and possibly fatal overdoses.

I see I’m over time. I’ll wrap that up there. I can probably say a bit more about this program and some of the other stuff in the presentation, but you all have it. I’ll turn it back to the Chair.

N. Sharma (Chair): Okay, thank you.

Over to you.

M. Serr: Thank you very much for having the B.C. Association of Chiefs of Police here today on this very important topic.

I also want to introduce Tiffany Parton, the executive director of the B.C. Association of Chiefs of Police, in the gallery.

Shane and I come with an enormous amount of experience in this — in the drug field. Shane is an expert in the drugs. Both he and I were on the core planning table for the decriminalization for the province, and I was also a co-chair with Health Canada on the expert task force, coming up with recommendations. So we have devoted a lot of time to try to manage and look for alternatives to addressing the overdose crisis.

I would like to start off by acknowledging the B.C. Association of Chiefs of Police acknowledges that we’re coming together from a number of ancestral, traditional and unceded territories. We acknowledge the homelands of the First Nations and Métis peoples for which we provide policing services to, and we respect Indigenous peoples as the original peoples of these lands.

I just want to start…. We have a lot of discussion. I think it’s important to talk about where we are in the drug climate right now. Certainly, for policing and enforcement, we have essentially been de facto decriminalizing drugs for probably about the last three or four years.

To give you some context, we’re going to use the RCMP data, because they have a broader range of remote, rural and urban communities here in British Columbia. In 2019, just over 1,600 drug charges were laid for possession. In 2020, that went down to just over 900. Where that charge resulted in a conviction, in ’19, it was 418. In 2020, that went down to 82.

Where, and this is important, the simple possession of drugs was the only charge…. So often a person will be charged when they’re also charged with a break and enter or a theft or something like that, and it’s an additional charge. Where it was actually the only charge, in 2019, it was only 50 for all of the RCMP locations, and in 2020, that was 14. So I can tell you that we have not been charging people for a long time. De Facto has been there.

In part, too, that is the Public Prosecution Service of Canada. It implemented, in 2020, a directive in which they would not accept criminal charges unless there was a public safety risk involving youth or persons in areas of authority. But also, in 2020, the Canadian Association of Chiefs of Police — which I represent, as well, on the drug portfolio — came out, too, with a recommendation that we look to decriminalize and find alternative measures or approaches to supporting people who use drugs.

I can also say those stats that you saw for the RCMP are very consistent with municipal police departments throughout British Columbia. We have all essentially tried to find health pathways as opposed to criminal charges. But despite that, I think what we’re seeing, and you’re seeing, is that the numbers continue to increase for overdose deaths. So what do we need to do differently?

I want to talk…. I’ll turn it over to Shane just to talk about drug trafficking and the drug toxicity.

S. Holmquist: Great. Thanks.

We’re seeing a surplus of fentanyl in British Columbia right now, and it’s about $35,000 a kilo. Just looking at some basic math there — this is why organized crime is involved — you can essentially make $65,000 off of a kilo of fentanyl.

Often traffickers front drugs, which means that when you have a person buying and a person receiving, there is no violence. It’s consenting people during that drug transaction. However, often drugs are fronted, meaning they’re given for free, and then there’s payment after the fact. That’s where a lot of this property crime and violence and things come into play.

People who possess drugs for personal use often drift in and out of the trafficking role, meaning if I was to get a deal on drugs, I would buy a little bit extra and then be able to sell to my friends. There’s often some recognition that when people are operating at that level, they don’t see themselves as traffickers, even though they do meet the definition in this Controlled Drugs and Substances Act for trafficking.

The next slide is on toxicity. This is kind of an important point to understand. When we get to the Q and A, I do have some little samples, inert vials here, if you wanted to look at what these quantities are. Essentially, you end up with hotspots, when you mix a highly concentrated product like fentanyl into material that is subsequently sold on the street. Mixtures range from 2 to 18 percent fentanyl. So we’re seeing quite a variety of concentrations out there.

[1:25 p.m.]

M. Serr: Just to give you context, when you think of a chocolate chip cookie…. You make five chocolate chip cookies. There’s a different number of chocolate chips in every cookie, and bluntly, that’s what’s happening. That’s why some drugs are highly, highly toxic and some have lower quantities.

We’re also seeing that the people who use drugs on the street are actually seeking out the higher quantities. As their tolerance becomes higher and higher, there is a demand. People often ask: “Why are people selling drugs if it’s killing the clients or the people who are buying it?” Well, it’s because people are always trying to look for the most potent drug. That’s what we’re seeing, and organized crime will always fill that void.

Just to talk about decriminalization. I think a lot of the conversation has been about that. As I said, the Canadian Association of Chiefs of Police came out with a report, a special purpose committee advocating for a decriminalized model. The B.C. Association of Chiefs of Police also supports that, but we see it as an incremental and integrated approach.

What we also know is that decrim alone is not going to solve this problem. We do need a suite of services, supports — and we’ll talk about that shortly — that are going to be able to support people who use drugs, families, the community as we move forward.

This is very complicated. Like I said, I have been part of so many committees, and discussing this is very complicated. We have said over and over that we won’t arrest our way out of this. But likewise, we’re not going to treat our way out of this, and many doctors have said that.

We really need to look at this from the children who are coming up to people who have experienced significant trauma to people who are currently in the cycle of drug use and all through. How do we find ways of health and support for these individuals? That’s a big question for the government to certainly address.

Shane and I were very engaged in the decriminalization conversation. Some concerns came up from the B.C. Association of Chiefs of Police regarding decriminalization. A lot of talk, as you heard, was about the thresholds. There is no real good data. Everyone was providing different data as to what is an appropriate threshold or not. To be honest, regardless of what the threshold is, the drugs that people are buying on the street, as Shane said, are highly toxic, and we really need to divert people away from that.

Our data that we received was people were typically…. In Vancouver and Abbotsford, about 1.9 grams was typically what a person would buy, when we were seizing it. In Victoria, it was 1.6. In northern RCMP areas it was 1.3, and that includes packaging. The numbers actually are quite a bit lower than those numbers of the actual drugs. So we are supportive of 2.5, and it’s consistent with what we see.

Public consumption. When we talk about stigma, the community…. A lot of times what we hear, as police chiefs, is that they are frustrated with public consumption. People can’t use marijuana. They can’t use alcohol in a public setting, and we can give provincial tickets. Yet the way things are written right now, someone can consume an illicit drug in a public area, and we don’t have the tools to address it. I think that will be a concern, moving forward.

We are all challenged, as you’ve heard from the fire, about no direct pathways, immediate access to health and support. Detoxes are not available for most of our communities, and the northern communities have really raised this as a significant issue. They don’t have the services available to help people.

Organized crime is always going to take advantage of any policy that you develop — unintended consequences. That’s why we were so strongly opposed to 4.5 grams. We knew they would manipulate that and have people carrying that much to sell.

One thing is that we will never, bluntly, get rid of the supply on the street. We have been in the drug business for a long time. No matter how big the drug seizures or arrests we’ve done, the supply will be there. That’s why it’s so critical to work on the demand, and that is something I think that you all will need to really put your mind to, because the illicit drugs will continue.

Is the health system ready? We don’t believe so. We need to stand that up. That’s not just beds. That, bluntly, is peer support. That is safer supply. It is a suite of packages that we need to stand up and stand up very, very quickly. We certainly saw that in Portugal before they went to decrim. They had the tools in place, and we should be chasing that.

We have heard, specifically from our northern police leaders, about consultation with our Indigenous communities up North, how we can support them, how we can interconnect and make sure the pathways and connections of helping them with the drugs in their communities are addressed.

For us, in policing, just some of the liability issues we also have a concern about. It breaks our hearts when we go to an overdose. Like fire, we revive somebody with naloxone. They want to walk away with no treatment, yet we have to leave them with two grams of the drug they just overdosed on. How is that going to support a person to a healthy pathway? Also, in good consciousness as a human, I have a hard time walking away from somebody who I know is going to do that drug again very quickly.

[1:30 p.m.]

To go through some of the recommendations that we have Right now for decrim, we would hand out cards, but there are no direct referrals or an ability for police officers to connect people to care, other than to give them a card and say: “Here’s what’s available in your community.”

In my community, we have what’s called Project Angel, which has now turned into the CEDAR project. Police officers can call somebody and connect them to a peer, and that peer can help find them the pathway or what they need. We are 365, 24-7, likewise with fire. We are not out of this space. We will have a spot in this space. This is an opportunity for us to have tools to help support people.

We’re not supporting, as many have called it, forced treatment. I don’t agree with that. That does not work. We know that. I also know that connecting someone with a peer when they’re ready to put up their hand is important. That’s what we need to do — or immediate access to opioid assisted treatment or agonist therapy.

Another recommendation, for us, would be to expand low-barrier drug rehabilitation and treatment programs. As I said, we don’t have enough here in the Lower Mainland. The people who work on that project, CEDAR, are absolutely frustrated that they cannot get a detox bed. People are just missing opportunities. In the northern region, that doesn’t exist. That scares me, bluntly. We need to have that in place.

Shane, I’ll have you do recommendations 3, please, and 4.

S. Holmquist: Recommendation 3 is improving low-barrier safer supply access options.

There was one study done at London InterCommunity Health Centre in Ontario. They found, using a safer supply program…. Criminal activity dropped from 48 percent down to 12 percent. They also found that homelessness reduced from 62 to 38 percent, and survival sex work reduced from 68 to 20 percent. There is some success — 118 people over a four-year period. I definitely suggest expanded safer supply and more studies to look at how effective that is.

Alberta has a virtual opioid dependency program. Essentially, very similar to what the fire chief said here, you can get a Sublocade injection within 24 hours after being released from police custody. If someone is arrested, found with drugs…. Those drugs, in Alberta, would be seized. Then that person could make a phone call, while in police custody, and, on their way out the door, go to a pharmacy and get this injection, which lasts for 28 days, and then go on the Suboxone program.

Lastly, here, recommendation 4, longer-term investments to improve social capital. Some of the things that we’ve seen are…. A lot of this harm reduction effort is great in the short term. In the long term, what does that look like for intergenerational use and trauma that’s not addressed and these types of things?

I was at a conference in Alberta in April. Very interesting. There were 910 people there, mostly from recovery agencies. Dr. David Best was there. I’ve provided some links at the bottom of the slide. He does have some really good information.

Alberta has actually put a document together — I can provide this to you as well; it’s a link at the bottom — talking about the recovery capital domains. They have a My Recovery program where someone can actually measure their social capital or their recovery domains and get on a recovery pathway. Recovery is different for each person. It doesn’t mean a full stop using of drugs. It could mean just partial use. So very interesting.

Looking at physical, mental health; family, social supports; and these types of things in the long run…. These interagency communications between employment and these activities play an integral part in recovery and building up that resistance to drug use and abuse.

M. Serr: To conclude, on behalf of the B.C. Association of Chiefs of Police, we will continue to advocate for an integrated approach to divert people who use drugs away from the criminal justice system. That’s what decrim is about. It’s about diverting people to different pathways. But we need those health services and those pathways of care so that we can support people, and the safer supply. As Shane said, it is a whole package.

One thing that’s often missed is the education for youth. That is something, of the four pillars, that we have seen, certainly, fall away in the last few years. We need to continue to educate and make sure that’s a big part of this.

From the policing perspective, we will — I can promise you — continue to focus our efforts on those that produce, traffic and import these drugs. As I said, drugs will always be on our streets. That’s why the government’s job is going to be to reduce the demand. That is our focus, and we hope that the courts will continue to hold those who are putting this poison out on the streets accountable. We look forward to continuing to work with stakeholders and finding those pathways of care and working together with our entire community to make a difference.

Just very quickly, in Abbotsford, which I represent…. This year, at the end of April, we’ve already had 32 overdose deaths. We’re on pace for our worst year ever, by a far margin. Last year, overall, we had 86 overdose deaths. We’re going to be over 100 this year.

[1:35 p.m.]

Not in those numbers — I hate just using numbers — is Liam. Liam died in May of a drug overdose. I spoke to his mother just last week. I’ve spoken to a lot of mothers, because this is something that means a lot to me. This is why this is such important work. I know you’ve had so many presentations. I know it’s exhausting. Liam’s mom just wanted to know: “How could I have saved Liam?” She didn’t have the answers, and I don’t have all the answers.

What I know is that if we all work together, if we all find solutions — this is not one group; this is every one of us doing what we need to do to invest in helping people — we will make a difference. I hope I don’t have to talk to any more mothers or fathers this year.

I just wanted to share with you. Next month, when the coroner’s report comes out, Liam will be one of our numbers. For me, he’s not just a number.

I thank you for your time.

N. Sharma (Chair): Thank you.

Okay, we’ll switch to question-and-answer.

Susie, go ahead.

S. Chant: I have one real quick question, two questions. One for police. What does PWUD mean — person who uses drugs?

M. Serr: Yes.

S. Chant: Thank you.

For first responders, the second responder program or plan or initiative…. How do you manage that for staffing?

L. Thomas: Off the side of my desk.

S. Chant: Okay. Trying to get somebody back the next day to go out and see somebody has to be a huge challenge.

L. Thomas: It is. We’re not staffed up for that program. We’re finding a way to make it work. It would be…. I’d love to have some evidence to show the effect of the program, because I think it would be a great candidate for some provincial funding. Not only do we have to make a commitment that’s not budgeted for; so does Fraser Health, with 1.6 FTEs on the clinician side and 1.6 FTEs on the peer worker side.

T. Halford: A question to fire. You said you’re predominantly first on scene. Is there anything, when you first get on scene, that you think you could be equipped to do but are not able to do?

Mike’s probably more familiar with this than anybody. I know that in the past, when we’ve met with firefighters, they’ve given us certain instances, whether it’s an EpiPen, things like that. This is obviously completely different. But is there anything…? If you guys are on scene, the majority of time, first, for sometimes long periods of time, is there anything that you’re not able to do that you think you should be able to do?

L. Thomas: In terms of an overdose response to someone that’s not breathing, we do have the tools.

I think my colleague Chief Fry indicated…. I believe it was in 2016 when the BCEHS doctor of medical programs equipped both our departments with the training to give intramuscular naloxone injections. So we’ve been doing that ever since.

If anything, what we’re missing is…. I think what my colleague indicated…. We probably need authorization to give larger doses than what we currently do. With the benzodiazepine issue right now…. We are limited to how many doses we can give, and then we have to wait for the paramedics to get there before more doses can be given.

K. Fry: Just me following up on that.

What we’re seeing is…. We’re beginning to train our firefighters in the city of Vancouver and some of our fire departments in our agency up to an EMR level so we can do pulse ox monitoring. We can also check blood sugars to ensure that it is an overdose and not a diabetic attack. But it is definitely the increase — the 0.8 — an EMR can give after, I think, two other 0.04 injections.

T. Halford: And you’re allowed to do what you just previously said — check the blood levels and everything?

K. Fry: Only at an EMR level. Not everybody is at an EMR level. We are slowly bringing our department up, at a cost to ourselves, which we’re paying for internally to do that. Currently some departments are, and some aren’t. It is a large process.

S. Furstenau: Thanks very much for your presentations. Recommendation No. 3: “Improve low-barrier safer supply access options.” You’ve got some examples here. Can you expand on that? What would that look like in the context of Vancouver, Abbotsford or B.C.? We’ve asked this of a lot of presenters. What does that mean, and what does that look like to you?

M. Serr: I’ll maybe start and then pass it to Shane, with some of his experience from Alberta.

[1:40 p.m.]

It has to be immediate access. People need to be able to get it. For example, you heard the example of Calgary or Alberta, where people can actually get it in a custody setting. We’ve been working with the Salvation Army in Abbotsford to have them connect with people who are in jail because of their drug addiction.

That is what we see predominantly. So many people are in custody because they’re committing what we call survival crimes in order to support their habit.

Instead of releasing a person and then [audio interrupted], they need to have that access in that setting. If one of our police officers, or fire, engages somebody, that needs to be a phone call to get somebody who can come and meet with that person and give them immediate access to a safer supply. I really believe that if it’s not easy and it’s not convenient, it won’t be utilized. So that has to be something that is very readily available to everybody.

One of the other…. I know that Mark Tyndall and I have talked about the vending machines. But there are so many barriers in place. When someone can only get, say, a one-day supply or one use, that’s not realistic in today’s world. Then people will eventually go to the illicit market, and that’s how many of these stories have ended, where I’ve heard that. So it [audio interrupted] be accessible. It needs to be available everywhere quickly, and it needs to be done in a way that’s going to be meaningful for individuals so that they’ll actually use it.

Then one of the questions…. Well, will people then sell? If we give them a two-day supply, will they sell it? I guess my argument would be — or they share it with friends — do we care? It’s safe. It’s safer than what’s on the street, bluntly. The stuff that’s on the street is going to kill you. It’s just whenever it will happen. I think we have to just really look at it differently.

But I also think — sorry, I’m going on a bit — that it also needs to be supported with a health approach. I always say a drug dealer is trying to sell you more drugs. That’s their job. Hopefully, a doctor and a safer supplier, a subscriber, is trying to moderate your drug use and eventually wean you down in the amount you use. That’s a big part of this. It’s not just giving people a safer supply. It’s also trying to work on the underlying issues.

Shane, I don’t know if there’s….

S. Holmquist: I think, maybe just to build on that, that it needs to be seamless and quick. So when people want out or to stop, you can’t follow up a week later and say, “Okay. Are you ready now?” because they’ve gone back to their social group. It’s readily accessible in the Downtown Eastside. It has to be, like, immediate and readily accessible. Absolutely.

This virtual opioid dependency program that Alberta started is in the process of rolling out into RCMP jurisdiction, but it’s in a lot of municipal police forces right now. They’ve said that they’re having fairly good success with that.

M. Starchuk: Mike, thank you for your prop. We had a prop that was here yesterday that was a stack of books, and that prop that you brought there just shined a light onto how personal this can be at times.

My question is for Larry. You talk about the lack of data that’s there. Can you give some anecdotal data with regards to the second responder program and any kind of an uptick?

L. Thomas: Sure. From the clients we see, it gets quite emotional for the team that responds. They will reach out and give the team member a hug and say: “No one’s ever cared about me before in my life.” So very impactful. Then, from the team perspective, they have similar stories. Like the client says: “This is the first time anyone has ever come to me and has cared about me. And yeah, I want follow-up information. How can I get it? Where can I get it?”

In terms of the data, that’s kind of where it ends from my oversight of the program, where we piloted and started this program and worked with Fraser Health to be our partner.

I should say that the Ministry of Health did give us a $50,000 grant to fund the peer worker when we first started to pilot the program. Then we got another $50,000 grant for year 2 in the pilot. But we haven’t got any grants since then, and this is the third year of the pilot.

What I can’t get from Fraser Health, because of privacy, is how many of the clients that we’ve reached out to, had contact with, have actually gone to Fraser Health at whatever point of entry, whether it’s a primary care clinic, whether it’s an ER, whether it’s a counselling appointment. They can’t easily collate our data to their data, and then they can’t, obviously, share private information. Hopefully there’s a way. I’m still trying to crack this with Fraser Health and give them as much information at the front end.

[1:45 p.m.]

If the person voluntarily will provide their health number or their birth date along with their name, we can provide that to Fraser Health, as they’re there at the interaction with the client. Then they can link records in the background within their environment, and then I can get aggregate numbers on whether we made…. I think we’re up to a couple of hundred contacts this year — how many and what percentage of those contacts actually followed through for help.

Now, I won’t be able to necessarily find out what the help was, but just that they are reaching out to Health. I think that’s where the opportunity is. That’s why I said that one of the gaps in our program is that if someone is willing to reach out for help, they need to get help right away. I think it backs up to what the police are saying about Alberta. If you can’t get them what they need right away, then they’re going to get back into their cycle of substance use disorder. Then, unfortunately, we probably go to another call.

Hopefully that answers the question.

M. Starchuk: If I can follow up.

N. Sharma (Chair): Go ahead.

M. Starchuk: I’m not sure if, Karen, you’re the one that wants to speak on behalf of the Fire Chiefs Association, but if Surrey is doing a pilot, is the intent that the B.C. Fire Chiefs Association logs onto the data and has this pop up elsewhere? I know we have an MLA from Prince George on the phone, and I’m pretty sure Prince George might be one of those places where they’d be able to facilitate something like this.

K. Fry: Thank you for that. I know it’s something that people are interested in, and it’s a matter of finding the resources and the partnership with the health areas. We are doing something very similar in Vancouver with Vancouver Coastal Health, but it is really finding the resources and the staffing available. I’m sure Chief Thomas would be willing to share. It’s not something we’ve talked about quite openly or had a motion from our membership on yet at this point.

P. Alexis: I too was interested in the data aspect, because without data, we don’t know how successful different initiatives are. One good thing about this group is that we’ve heard, I don’t know, probably over 100 presentations where we’re gleaning the recommendations. This very well could be a recommendation — that we make sure that data is captured so that we can indeed determine if you’re successful. So it’s really important that you share as much as you can with us.

Thank you, Mike, for asking that question.

One thing we’ve been told in previous presentations is that each province has a slightly different problem. The problems of Ontario may be different than those of Alberta, yet again in British Columbia. Does that at all impact your sharing of information or looking at best practices at all in other provinces?

I have another question for you too, but it was just that one first.

L. Thomas: In the fire service, we don’t get great data sharing across the provinces. We, at least in my environment, do have a research analyst that will reach out and look for papers, published documents related to the subject so that we can be informed. We did the research and found the West Virginia example — again, a smaller-town story. There was a nurse that became a fire chief and saw this opportunity to make a difference in their community, and they had really good results. They cut their deaths in half over a two-year period.

You take that idea and concept from that contact and then try to adapt it to the environment that we’re in. I think your point is valid that it’s different. Downtown Eastside Vancouver is different than the downtown core of Surrey. They’re different town centres that have issues. The underlying problems may be the same, and the unsafe street supply is probably the same, and the drug dealers are probably the same. But the solutions need to fit to the local government experience and what resourcing you have and the ability to do these programs.

P. Alexis: Right. Good point.

Is it okay to ask another question of Chief Serr, if I could?

All of the presentations have included a dip in 2019 in the number of deaths. You presented, certainly, that…. For example, in the decrim aspect, there were very few arrests over time for possession, What do you attribute the dip in 2019 to, given the circumstances of where we were already headed as far as what was acceptable, what was not acceptable, and that kind of thing?

M. Serr: It’s a very good question, something we’ve talked about. If we knew the answer, hopefully that would help us move forward.

[1:50 p.m.]

In part, and I think you’ve heard it from the Fire Chiefs Association, people are exhausted. I think 2016 is when it was declared. In 2017-18, we were all part of so much work to try to disrupt and to deal with the opioid crisis, and I think we were starting to gain ground, and we were starting to see some benefits of that. Then in 2019, that’s where it happened.

Then comes ’20, and we’re all fully engaged in COVID. Then of course, supervised consumption sites aren’t as readily available. Bluntly, we have the data that drug dealers took advantage of the CERB payments. We knew that that money was, in some cases, being utilized to buy more drugs, and then all the ground that we gained, we lost. Of course, people who are…. We’re talking, people in the health…. I mean, everyone is just exhausted. I think that’s traction we lost.

I think if you look pre-’18, ’19, you’ll see that all, some of the good work was starting to really benefit, but of course, it was all hands on deck for some other priorities and crises.

P. Alexis: Can I just add a comment? We had a presenter in — I think it was yesterday; I can’t remember; the days run into each other — that said COVID was like being in World War II, and we haven’t seen, necessarily, all the impacts as a result of a world war. I think about that and about how exhausted everybody is and how fragile people are. You know, they’ve just had so much…. It’s like a different world completely.

I appreciate everything that you do.

I did have one more question but….

N. Sharma (Chair): Ronna-Rae, go ahead.

R. Leonard: Two questions, one just for clarification. Sublocade — is that like an equivalent to antabuse? I didn’t get whether it was an actual opioid agonist therapy or if it was something to prevent people from taking drugs because it will not be pleasant.

S. Holmquist: They actually have a website, and the information is available through the Alberta model. Essentially, it lasts 28 days since the initial injection, and it curbs the desire and reduces the effect of drug use.

R. Leonard: Okay. So it has to be somebody who is beyond contemplative that they actually want to disassociate.

S. Holmquist: It’s someone who’s made the conscious decision to move forward, yes.

R. Leonard: Okay. Then my second question is around one of your recommendations around being able to refer. We were introduced by the RCMP to situation tables, which is an opportunity to decrease the involvement of police and increase the involvement of those who need to be really at the front door. I’d just like you to comment on that as one of the avenues for being able to see those referrals happening and being a part of that bigger team.

M. Serr: I would say that that was one of the things that I was frustrated with. We looked at other models — Portugal, Oregon — different models, where when a police officer had contact or came in contact with a person who was using drugs, instead of being arrested, they were given a referral or support and a persuasion commission or different things like that.

Here, it was very clear that that was something that organizations representing people who use drugs did not want. They did not want the police…. And they felt that that actually would set some of the treatment options back — or people wanting to take that option.

Where we’re moving forward with it is that we would hand out a card which would give the organizations or areas where you can get help within that community. I’m concerned, bluntly, that that is not enough. I have personally talked with people on the road, on the street, who have been using drugs, and they want help. But for me just to give them a card I don’t think is the help that they’re going to need.

I think what we need to do, like what we tried in Abbotsford with Project Angel, is for me to be able to call somebody 24-7 from the health, stand up the health, who’s going to come and meet with that person and help guide them in the pathway. I’m not saying that should be police or fire. We have a lot of other responsibilities, but if health…. We keep hearing this is a health priority. Health has to step up. Health has to be 100 percent invested. When we deal with something like this, health has to have 24-7-365 services available on the street to help people. That currently does not exist.

[1:55 p.m.]

S. Holmquist: If I could just add to that, one thing that I found when I was in uniform policing, when I first started, was that when someone wanted help, you couldn’t just put them in the back of the police car and drive them to a facility. That has not been in place for a long time. I think if something like that existed, where we could have that contact….

We’re out there 24-7 on the street. To be able to have that handoff 24-7 I think would be key because, again, people’s [audio interrupted] change. They get back in the social network. Drugs are readily available. When they’re ready to make that conscious decision, you have to act on it, and we have to get them into health as soon as they make that decision.

N. Sharma (Chair): I have a question before we go to the next round. Thanks, everybody, for their presentations. What has been remarkable for me, as we’ve seen and heard from lots of people in different roles and perspectives on this issue, is this commonality, not only in the compassion that people show up with but also in some of the things that would help people and set them on the right path. I definitely heard that today.

One thing that really struck me was, I think, what you talked about: the fact that we’re not going to get rid of the supply but that we have to deal with the demand. We’ve just been learning about the crushing toll that fentanyl takes on the person that’s on it and how, basically, your dose gets higher and higher, and it’s like this chase to withdrawal. It lasts about 25 minutes or something, the high, and then you’re back on the cycle. It just seems so relentless and brutal to people.

I think you all talked about how first responders that are embedded in the community are seeing this in a lot of ways. I just am really wondering about what you do with that kind of relentless development of this supply of drugs that is so terrible for people. Is it really just like the demand that we work on and help people get all of the great ideas that you’ve brought forward, of the help they need? Or is there something about the toxic supply and what we do about that?

M. Serr: We’ve certainly had a lot of conversations about drug testing, where people can test their drugs and just get a sense of whether they’re safe or not. Someone that might, for example, want to use cocaine in an environment that’s a party environment, could test it, find out that it has fentanyl and choose not to use it.

Bluntly, we’re seeing fentanyl in most of the hard drugs. That’s the reality: if you’re using cocaine, methamphetamine, MDMA, there’s a good chance that at one point you’ll have fentanyl within those drugs somewhere. That is one thing that certainly has been discussed. That’s a problem.

For everything we do, there’s always an unintended consequence. Organized crime is always looking for opportunity and, as Shane said, in 2016, was originally bringing in fentanyl, pure, from China, and now that has changed. Now what we’re seeing is totally domestic production, for the most part, and people are actually producing it. Like the toxicities, we were scared of…. Remember the granules of salt? It was a conversation we talked about. Now people are able to use 18 percent of the quants. I mean, those are extraordinary numbers. We were afraid of….

Can we do anything? We continue to go after those that are producing it, and we’re doing all that. We share data, and we’re trying, but organized crime will always want to produce a product that the community using drugs wants. That’s why reducing the demand, bluntly, is a slow play that will take time. Education is a long play. But we have learned over time, with a lot of things: if we invest now, at the early stages, we will make a difference.

Is this going to stop overnight? I wish I could tell you it would, but it won’t. The drugs will still be out there, but if we start doing things incrementally, I think we can make a change over the next five years.

N. Sharma (Chair): Okay. We have two more people with questions. Let’s see if we can get them both in, in the next two minutes.

P. Alexis: I just had a question about language barriers, for Chief Thomas. You told us that you leave literature in the home, to try and encourage people to get help. So I am assuming that you have a multi-language approach to this.

L. Thomas: Yeah, Fraser Health provides the educational information, and they do provide it in multiple languages.

P. Alexis: I just wanted to check. Thank you.

M. Starchuk: Mike, to your point, health care needs to be at the table. I mean, there’s no doubt about it. We heard it, from police, fire and ambulance today, that everybody has programming that’s there that deals around the client, whether or not it’s pre- or post-overdose, in trying to get them to the health care that they need.

[2:00 p.m.]

The comment that you’d made earlier on, and that I’d really like to touch on, is that you’re on track to set a record on the amount of overdose deaths, despite everything that we’re doing, and despite the fact that we have, as you say, a domestic product. We knew where it came from, and now we don’t know where it comes from.

We know safer supply will be an answer. Will it be the best answer? We’re not sure. I’m not sure. It will be part of those steps, no different than decrim is, at the same time. What’s the answer to where?

M. Serr: As far as where the supply…?

M. Starchuk: Yeah.

M. Serr: That just continues to shift. It’s a moving target for us.

We are working very hard to try to invest in those investigations. They are very complex, expensive investigations run by CFSEU. The investment in groups that can do those long-term, very difficult investigations — i.e., CFSEU, which is a provincially funded body — will continue to be important.

The amount that we are taking away from these labs is unbelievable. It’s being sent all across Canada. So we have to continue to focus on that. Like I said, it’s Whac-a-Mole. It really is. We take down one or two labs, and there are four more that are producing a high quantity.

I think what you said is very well said. It’s not one thing. It’s going to be a suite of tools that are going to eventually make the difference over a period of time. We all have a role. Our role is the enforcement side and to continue to make it uncomfortable for organized crime and others. There are so many other roles.

S. Holmquist: I am part of a national fentanyl working group. CBSA is a part of that. We have conversations about a lot of the precursor chemicals that come in.

In addition to CFSEU, the RCMP FSOC, federal serious and organized crime section, does do a lot of controlled delivery–type investigations of these precursor chemicals to try and identify these labs.

One of the challenges is…. A lot of these chemicals are regulated in the CDSA. All you do is manipulate a molecule, and then it becomes an unregulated substance. All they have to do is just go through a molecule change process, and then they’ve got their precursor chemical. It’s a constantly evolving strategy of where they’re manipulating molecules so it doesn’t meet that scheduled substance.

N. Sharma (Chair): Okay. I think those are all of our questions. On behalf of the committee, I just want to thank you not only for the work that you do every day but also for being here and helping us learn from your perspective. It’s been really valuable for all of us, and we appreciate your time.

I guess if people want to take a look at the things you’ve brought in, we can do that.

Before I do that, I need a motion to adjourn.

Ronna-Rae and Trevor.

Okay, we’ll see everybody next week.

The committee adjourned at 2:02 p.m.